球囊扩张结合腰肋悬空仰卧位经皮肾镜取石术的临床研究

Application of balloon dilatation combined with flank supine position in percutaneous nephrolithotomy

目的 探讨球囊扩张器结合腰肋悬空仰卧位在经皮肾镜取石术中的应用和安全性.方法 回顾性分析2012年7月至2013年9月收治的60例肾结石患者的临床资料,按手术方式分为球囊组（采用球囊扩张器扩张）和套管组（采用筋膜扩张套管扩张）,每组30例.两组患者的性别、年龄、体质指数、结石位置和大小比较差异无统计学意义（P＜0.05）.手术均由同一组医师完成,分别记录两组的一次穿刺扩张成功率、成功建立通道时间、穿刺并发症（肾盏破裂、肾周积液及术后延迟性出血等）、清除结石所需时间和结石清除率等.结果 球囊组和套管组一次穿刺成功率[100％（30/30）和90％（27/30）]、成功建立通道时间[（6.1±2.3）min和（13.3±3.6） min]、穿刺并发症发生率[3％（1/30）和13％（4/30）]和清除结石所需时间[（11.7±2.0）min和（21.5±3.1） min]比较差异均有统计学意义（P＜0.05）;结石清除率[87％ （26/30）和83％ （25/30）]比较差异无统计学意义（P＞0.05）.结论 球囊扩张器结合腰肋悬空仰卧位经皮肾镜取石术操作简单,能更有把握、更快地建立好碎石通道,缩短碎石时间,降低手术并发症的发生率.

Objective To access the practicality and safety of a new type Balloon dilatation com- bined with flank supine position in percutaneous nephrolithotomy. Methods Clinical data of 60 kidney stones patients were collected and retrospectively analyzed. This group of patients had been admitted and se- lected according to the inclusion criteria in our institute from July. 2012 to Sep. 2013. There was no obvious difference in sex, age, body mass index （BMI） , stone location and size. According to the surgery approa- ches, this group of patients was divided into balloon group （dilated by balloon dilatation） and Amplatz group （dilated by Amplatz [ascial dilation） and in each group there were 30 cases. All these patients received the surgery by the same group of surgeons. We collected the data of one-time success puncture rate, success puncture time, puncture complications （kidney calices fracture, perinephric fluid collection and postopera- tive delayed hemorrhages etc.） , removing stones time and stone free rate. Results Compared with Balloon group, Amplatz group had a significant difference （P〈0.05） in one-time success puncture rate [ 100% （30/ 30） vs 90% （27/30） ] , success puncture time [ （ 6.1 ±2.3 ） rain vs （ 13.3±3.6） rain ] , puncture complica- tions [3%（1/30） vs 13%（4/30）1 and removing stones time [（11.7±2.0）min vs （21.5±3.1）,nin]; but no significant difference （P〉0.05） in stone free rate [ 87% （26/30） vs 83% （25/30） ]. Conclusions Balloon dilatation combined with flank supine position in percutaneous nephrolithotomy is easy for surgery. It can establish the surgery access more accurately and faster, decreases removing stones time and reduces op- erative complications.