刺激性利尿取石通道建立技术的安全性和有效性研究

Research of safety and efficacy of tract creation technique with stimulated diuresis on PCNL surgery

目的:本研究旨在研究和评估刺激性利尿取石通道建立技术在经皮肾镜取石术(PCNL)中的安全性和有效性。方法:回顾性分析2016年1月～2018年6月在我院接受PCNL手术治疗的241例患者的病例资料,其中采用逆行输尿管插管技术建立取石通道114例(逆行输尿管插管组),采用刺激性利尿技术建立取石通道127例(刺激性利尿组)。比较两组通道建立时间、肾脏出血、肾功能、通道建立失败、集合系统穿孔、结石下移进入输尿管、顺行留置双J管失败等指标。结果:逆行输尿管插管组和刺激性利尿组在通道建立时间、术后血红蛋白(Hb)下降值、术后肌酐(Cr)变化值等方面比较差异无统计学意义(P>0.05)。逆行输尿管插管组有1例向肾盂逆行注水后集合系统声像突然变得模糊,无法辨认肾脏集合系统结构导致穿刺困难,但仍然成功完成穿刺和取石手术。两组所有患者均成功建立取石通道,无穿刺失败及通道丢失等病例;无结石碎片下移进入输尿管中下段而需要改行截石位下输尿管镜处理的病例。结论:刺激性利尿取石通道建立是一种安全有效的通道建立技术,可以代替逆行输尿管插管取石通道建立技术。

Objective:To evaluate the safety and efficacy of tract creation technique with stimulated diuresis on percutaneous nephrolithotomy(PCNL).Method:In this retrospective study,241 cases who underwent PCNL at our hospital from Jan.2016 to Jun.2018 were enrolled.One hundred and fourteen patients underwent PCNL with retrograde introduction of ureteral catheter and 127 cases accepted PCNL with stimulated diuresis(e.g.without retrograde introduction of ureteral catheter).Tract creation time,renal hemorrhage,overall renal function,tract dilation failure,perforation of collecting system,immigration of stone fragments down into the ureter and failure of antegrade placement of ureteral stent were compared between the two groups.Result:There was no significant difference in mean(SD)tract creation time,mean(SD)decrease in hemoglobin concentration or overall renal function between the two groups(P>0.05).There was no dilation failure,perforation of collecting system or immigration of stone fragments down into the ureter cases presented in both groups.It was difficult to perform the collecting system puncture in one patient in retrograde introduction of ureteral catheter group when normal saline was perfused into the collecting system and the structure of collecting system got blurred under ultrasonography scanning,though we finished the punctures and PCNL surgeries on both patients at last.All cases were established the tract successfully.There was no puncture or tract creation failure case in both groups.Conclusion:The tract creation technique with stimulated diuresis on PCNL was safe and efficacious.