球囊扩张导管与筋膜扩张器在无积水肾建立经皮肾通道的临床对比研究(136例)

Comparison of balloon dilator and amplatz dilator in establishing percutaneous nephrolithotomy access(136 cases)

目的对比使用新型球囊扩张导管与筋膜扩张器在无积水肾建立经皮肾通道的成功率及并发症情况,评价新型球囊扩张导管的实用性、有效性及安全性。方法回顾性分析郑州大学附属洛阳市中心医院在2010年1月-2013年11月收治的136例无积水肾结石患者的临床资料,76例患者采用球囊扩张器建立通道,60例患者采用筋膜扩张器(Amplatz扩张器)建立通道。比较两组患者在扩张成功率、通道建立时间、手术时间、术前术后血红蛋白变化、结石清除率、术后平均住院日以及住院费用等方面的差异。结果使用球囊扩张器建立通道的时间短于筋膜扩张器,(13.1±1.8)min vs(20.5±2.9)min(t=3.19,P<0.05),差异有显著性;球囊扩张组的平均手术时间明显也低于筋膜扩张器组(78.5±16.9)min vs(95.6±24.0min),(t=4.23,P<0.05)。球囊组术后血红蛋白下降幅度小于筋膜扩张器组,差异有显著性(1.08±0.98)g/d L vs(1.72±1.02)g/d L(t=3.35,P<0.05),两组患者在一次性扩张成功率(χ2=5.79,P<0.05)及术后早期结石清除率上(χ2=6.20,P<0.05)存在显著差异,采用球囊扩张器的患者平均住院费用高于筋膜扩张器组,差异有显著性。结论新型球囊扩张导管在无积水肾经皮肾通道的建立中优于筋膜扩张器。

[ Objective ] To evaluate the safety and efficacy of two kinds of dilation of passage, with balloon or fascial dilator, for the renal calculus in non-dilated collecting system in percutaneous nephrolithotripsy. [ Methods ] 136 patients with renal calculus in non-dilated collecting system during January 2010 to November 2012 were retro- spectively reviewed .The dilation success rate, tract formation time, total operating time, preoperative and postopera- tive hemoglobin concentrations, stone free rate, average postoperative hospital stay and the cost of hospitalization were compared between the two groups. [ Results ] The tract formation time of balloon group was shorter than that of Amplatz group （13.1±1.8） rain vs （20.5±2.9） min; （t =3.19, P 〈0.05）. And the total operating time of balloon group was shorter too （78.5±16.9） min vs （95.6±24.0） min; （t =4.23, P 〈0.05）. The hemoglobin decline of the balloon group was （1.08±0.98） g/dL and that of the Amplatz group was （1.72±1.02） g/dL, which had significant difference （t =3.35, P〈0.05）, There were significant differences in dilation success rate （X2=7.32, P 〈0.01） and stone free rate （X2=8.80, P 〈0.01） between the two groups. The cost of hospitalization was higher in the balloon group than the Amplatz group. [ Conclusion ] The establishment of passage with balloon for renal calculus in non-dilated collecting system appearsto be better than Amplatz dilator in some aspects.