逆行输尿管插管与刺激性利尿经皮肾镜取石术安全性和有效性的对比研究

Research of safety and efficacy on PCNL with or without retrograde introduction of ureteral catheter

目的:本研究旨在研究和评估无逆行输尿管插管经皮肾镜取石手术(PCNL)的安全性和有效性,探讨无逆行输尿管插管PCNL的适应证和禁忌证。方法:回顾性分析2013年1月~2016年12月在我院接受PCNL手术治疗的367例患者的病例资料,其中行逆行输尿管插管PCNL手术224例(逆行插管组),行刺激性利尿PCNL手术143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、结石下移进入输尿管、顺行留置双J管失败等指标。结果:逆行插管组和刺激性利尿组通道建立时间、术后血红蛋白(Hb)下降值、术后血清肌酐(Cr)变动值等指标差异无统计学意义(P>0.05)。两组均无通道建立失败病例,无结石下移进入输尿管而需截石位下输尿管镜取石手术病例。逆行插管组有2例在逆行向肾盂内注水后肾脏集合系统积水声像消失,无法准确定位目标肾盏穹窿,导致穿刺困难。刺激性利尿组有1例无积水肾盂结石且肾实质厚实的患者,刺激性利尿人造肾积水效果不佳,导致目标肾盏穿刺困难,但仍顺利完成穿刺和取石手术。结论:经皮肾镜取石术中无逆行输尿管插管而改为刺激性利尿替代来人造肾积水是安全和可行的。无肾盂积水且肾实质厚实可以作为刺激性利尿PCNL的相对禁忌证。

Objective：To evaluate the safety and efficacy of percutaneous nephrolithotomy（PCNL）without retrograde introduction of ureteral catheter（e.g.stimulated diuresis PCNL）.And also we try to discuss the indications and contraindications of PCNL without retrograde introduction of ureteral catheter.Method：In this retrospective study,we enrolled 367 cases who underwent PCNL at our hospital from January 2013 to December 2016.Two hundred and twenty four patients underwent PCNL with retrograde introduction of ureteral catheter and 143 accepted PCNL with stimulated diuresis（e.g.without retrograde introduction of ureteral catheter）.Tract creation time,renal hemorrhage,overall renal function,tract dilation failure,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 on mean tract creation time,mean decrease in hemoglobin concentration or overall renal function between the two groups（P〉0.05）.There was no dilation failure or immigration of stone fragments down into the ureter cases presented in both groups.It was hard for us to finish the aim calyx puncture in one patient in stimulated diuresis group with thick renal parenchyma and without hydronephrosis,though we finished the PCNL without retrograde induction of ureteral catheter at last.Conclusion：The stimulated diuresis PCNL is safe and efficacious.The presence of thick renal parenchyma without hydronephrosis may be taken as a contraindication of stimulated diuresis PCNL.