内镜直视下扩张在无积水肾建立经皮肾通道中的临床应用

Clinical application of endoscopic dilation technique in the channel establishment of minimally invasive percutaneous nephrolithotomy without renal water

目的评估内镜直视下扩张技术在无积水肾建立微创经皮肾取石术（minimallyinvasivepercutaneousn印hrolithotomy，mPCNL）通道的安全性、可行性和实用性。方法2015年1月至2016年8月，依据采用Amplatz扩张器筋膜扩张方式的不同，将126例mPCNL的患者分为2组，内镜直视扩张组（65例），采用内镜直视下扩张法；筋膜扩张组（61例），在X线引导下依序逐步筋膜扩张法。对比两组患者的通道建立时间、通道一次建立成功率、手术时间、术中出血量、一期结石清除率、术后住院时间等。结果两组患者均成功实施mPCNL，两组通道建立时间【（11．44±7．9）min vs（23．30±11．6）min】、通道一次建立成功率（100％vs78％）、手术时间【（51．72±7．4）rainVS（82．67±6．9）min】、术中出血[（43．47±9．23）ml vs（96．47±22．76）ml】组间比较差异有统计学意义（P〈0．05）。两组一期结石清除率、术后住院时间组间比较差异无统计学意义俨〉0．05）。结论内镜直视扩张建立经皮肾通道安全、实用、可行性高，明显优于传统的筋膜扩张组，值得在临床上推广应用。

Objective To evaluate the safety, feasibility, and practicability of endoscopic dilation technique in minimally invasive percutaneous nephrolithotomy （mPCNL） without renal water. Methods From January 2015 to August 2016, 126 patients scheduled for mPCNL were divided into 2 groups according to the different ways of expanding fascia by Amplatz dilator. Endoscopic dilation group （65 cases） was under endoscopic dilation, fascia expansion group （61 cases） was produced by fascia expansion step by step under X-ray guidance. Compared the channel establishment time, channel primary success rate, operation time, the amount of bleeding during operation, the rate of stone clearance in one stage, postoperative hospitalization of two groups. Results The patients in two groups were successfully implemented mPCNL. There were statistically significant differences in channel establishment time, channel primary success rate, operation time, and the amount of bleeding during operation between two groups [（11.44±7.9）min vs （23.30±11.6）min, 100% vs 78%, （51.72±7.4）min vs （82.67±6.9）min, （43.47±9.23）ml vs （96.47±22.76）ml; P〈0.05]. There were no statistically significant differences in the rate of stone clearance in one stage and postoperative hospitalization between two groups （P 〉 0.05）. Conclusion It is safe, practical, and feasible to set percutaneous renal channel by endoscope, which is superior to the traditional fascia expansion, worthy of clinical application.