改良COOK撕开鞘握持方法在建立经皮肾通道的应用

Application of modified method of holding COOK peel-away sheath in establishing percutaneous renal access

目的探讨改良COOK撕开鞘握持方法在建立经皮肾通道中的应用价值。方法回顾性分析采用改良法建立的40条经皮肾通道和采用常规方法建立的35条通道的临床资料,并比较两种方法的有效性和安全性。结果常规组和改良组均成功建立了皮肾通道;通道建立时间分别为(12.5±5.0)min、(11.5±4.5)min,差异无统计学意义(P>0.05);结石取尽率常规组82.9%(29/35)、改良组82.5%(33/40),差异无统计学意义(P>0.05)。常规组通道扩张过深7个(其中肾脏无积水和轻度积水6个、中度积水1个)、改良组无通道扩张过深病例,差异有统计学意义(P<0.01);常规组2例患者因对侧实质出血影响碎石改二期手术;血红蛋白降低值常规组(11.0±3.0)g/(L·通道),改良组(10.5±2.0)g/(L·通道),两者之间差异无统计学意义(P>0.05)。结论采用改良法使用COOK撕开鞘,操作简单、能避免筋膜扩张器带入过深导致的肾实质出血、安全性更高。

ObjectiveTo investigate the applicative value of the modified method of holding COOK peelaway sheath in establishing percutaneous renal access.MethodsThe clinical data of 40 percutaneous renal accesses established by modified method and data of 35 accesses established by conventional method were reviewed.The efficacy and safety were compared.ResultsThe renal accesses were established successfully in both groups.The average time used was （12.5±5.0） min vs. （11.5±4.5） min in the conventional group and modified group; the stonefree rate was 82.9% vs. 82.5%; the hemoglobin decrease was （11.0±3.0） g/L vs. （10.5±2.0） g/L,with no statistically significant differences （all P〉0.05）.In the conventional group,the access was too deeply dilated in 7 cases （6 with mild or without hydronephrosis,1 with noderate hydronephrosis）,and 2 patients had to receive phase Ⅱ operation because of parenchymal hemorrhage,while none such conditions occurred in the modified group （P〈0.01）.ConclusionThe modified method is not only an effective method,but also can avoid contralateral renal parenchymal injury caused by fascial dilator in establishing the percutaneous renal access.