彩超引导下肾盏穹窿部穿刺在经皮肾结石取石术中的应用

Clinical application value of calyceal fornix puncture guided by ultrasound in percutaneous nephrostolithotomy

目的：探讨彩超引导下肾盏穹窿部穿刺在经皮肾结石取石术（PCNL）的应用效果。方法：同一术者手术的298例次一期PCNL,其中彩超引导下肾盏穹窿部穿刺建立经皮肾通道142例次（RF组）,非肾盏穹窿部穿刺156例次（NRF组）。所有患者术前均行CT尿路造影检查,有合并症者予降压、降糖、抗感染等对症处理,尿脓毒症合并肾积水的患者如抗感染效果不佳则予肾穿刺置管引流,待各合并症处理相对平稳后再行手术治疗。比较2组患者的PCNL通道数量、通道直径（有多个通道的取平均直径）、建立通道出血率、PCNL时间、一期清石率、术后出血时间、输血率、肾动脉栓塞率。结果：RF组在建立通道出血率、PCNL时间、术后出血时间、输血率等方面均少于NRF组（P〈0.05~P〈0.01）,而一期清石率则高于NRF组（P〈0.05）。2组通道数量和通道直径差异均无统计学意义（P〉0.05）。结论：彩超引导下肾盏穹窿部穿刺在减少PCNL出血的同时可以缩短手术时间,提高一期清石率,并更有机会使用大通道。

Objective： To evaluate the clinical application value of calyceal fornix puncture guided by ultrasound in percutaneous nephrostolithotomy（ PCNL）. Methods： Two hundred and ninty-eight patients treated with primary PCNL were treated with calyceal fornix puncture guided by ultrasound（ 142 case,RF group） and non-calyceal fornix puncture（ 156 cases,NRF group）. All cases were detected by CTU before operation. The patients with hypertension were treated with antihypertension,reducing blood sugar and antiinfection. The patients with urosepsis complicated with hydronephrosis were treated with renal drainage if the antiinfection effect was poor,and the patients were operated after the complication was improved. The tract number and diameter（ average diameter of multitract）,operation time of PCNL,tract bleeding rate,PCNL time,primary stone free rate,postoperative bleeding time,transfusing blood rate and renal artery embolization rate between two groups were compared. Results： The tract bleeding rate,PCNL time,postoperative bleeding time and transfusing blood rate in RF group were less than those in NRF group（ P〈0. 05 to P〈0. 01）,and the primary stone free rate in RF group was higher than that in NRF group（ P〈0. 05）. The differences of tract number and diameter between two groups were not statistically significant（ P〉0. 05）. Conclusions： The calyceal fornix puncture guided by ultrasound can decrease the bleeding and shorten operation time of PCNL,increase the primary stone free rate,and has a chance to use large size tract.