22F通道结合双J管反流人工肾积水经皮肾镜治疗肾结石

The use of 22 F tract combined with double J tube reverse flow artificial hydronephrosis in percutaneous nephrolithotomy (PCNL) for the treatment of renal stone

目的比较22 F通道和16 F通道经皮肾镜治疗肾结石的临床疗效,并研究双J管反流人工肾积水临床疗效。方法回顾分析2011年8月至2014年6月在江苏省淮安市第二人民医院泌尿外科接受不同通道经皮肾镜治疗的49例肾结石患者临床资料。16例行22 F单通道(A组)、14例行22 F单通道及双J管反流人工肾积水(B组)、12例行16 F单通道(C组)、7例16 F单通道及双J管反流人工肾积水(D组)经皮肾镜碎石取石术。分析比较各组在通道建立时间、手术时间、术中出血量、一期结石取净率、术后并发症等指标方面的差异。结果各组患者均成功进行经皮肾镜碎石。A与B组比较:A组通道建立时间明显长于B组[(7±2)min vs(3±1)min,P<0.05],手术时间亦长于B组[(65±23)min vs(50±20)min,P<0.05],两组术中失血量、一期结石清除率和术后发热率无显著差异(P>0.05)。A组与C组比较,手术时间明显缩短[(65±23)min vs(82±19)min,P<0.05]。其余方面无统计学差异(P>0.05)。C组与D组比较,手术时间及通道建立时间方面C组明显长于D组[(82±19)min vs(71±17)min,(6±1)min vs(3±1)min,P均<0.05]。结石清除率及出血方面无差异(P>0.05)。B组与D组比较:手术时间缩短[(50±20)min vs(71±17)min,P<0.05],通道建立时间、出血及结石清除率方面无明显差异(P>0.05)。结论 22 F通道结合双J管反流人工肾积水经皮肾镜碎石取石术与传统微通道手术相比具有缩短手术时间及通道建立时间、安全、实用可行等优点,值得临床推荐。

Objective To compare the outcomes of 22F tract combined with double J tube reverse flow artificial hydronephrosis and 16 F tract in PCNL for the treatment of renal stone. Methods 49 cases with renal stone received 22F and 16 F tract PCNL from August 2011 to June 2014, sixteen cases were treated by PCNL with single 22F tract（Group A）, 14 cases were performed by PCNL with single 22F tract combined with double J tube reverse flow artificial hydronephrosis（Group B）, 12 cases were treated with single 16 F tract（Group C）, other 7 cases underwent 16 F tract combined with double J tube（Group D）. The clinical data including tract establishment time, operation time, blood loss, stone-free rate and complications were compared between Group A and Group B, Group A and Group C, Group C and Group D, Group B and Group D were analyzed retrospetively. Results The operations in all groups were performed successfully.The tract establishment time and operation time in Group A were longer than that of Group B [（7 ±2） min vs（3±1） min,（65±23） min vs（50±20） min, all P〈0.05]. In addition, the amount of blood loss, stone-free rate and fever in both Group A and Group B were not significantly different（P〉0.05）. The operation time of Group A was shorter than that of Group C [（65 ±23） min vs（82 ±19） min, P〈0.05]. The amount of blood loss, stone-free rate and fever in both Group A and Group C were also not significantly different. The operation time and tract establishment time of Group C were longer than that in group D [（82 ±19） min vs（71±17） min,（6±1） min vs（3±1） min, P〈0.05]. The differences of stone-free rate and the amount of blood loss had no significant differences. The operation time of Group B was shorter than that of Group D significantly [（50±20） min vs（71±17） min（P〈0.05）]. The tract establishment time, hemorrhage and stone-free rate of Group B and Group D group were not significantly different（P〉0.05）. Conclusions The tract establishment time and operation time of 22F tract combined with double J tube reverse flow artificial hydronephrosis are shorter than that of traditional 16 F tract. In addition, 22F tract combined with double J tube can increase stone removal speed. The amount of blood loss, stone-free rate and fever in all groups have no significant difference.