超声引导下SVOF原则两步穿刺法建立经皮肾镜工作通道的临床研究

Clinical investigation of ultrasound-guided percutaneous nephrolithotomy accessed by SVOF-principle and two-step puncture techniques

目的探讨超声引导下俯卧位SVOF原则两步穿刺法建立经皮肾镜工作通道的安全性和有效性。方法回顾性分析2007年6月至2015年12月华中科技大学同济医学院附属同济医院泌尿外科同一医疗组连续收治的838例经cT平扫诊断为肾脏或输尿管上段（Ld横突以上）结石并施行超声引导下经皮肾镜取石术的患者的临床资料。425例患者采取俯卧位超声定位下积水肾盏直接穿刺法建立经皮肾镜工作通道（对照组）；413例患者采取俯卧位超声引导下SVOF原则两步穿刺法建立经皮肾镜工作通道（SVOF组），SVOF原则包括短距原则、高点原则、钝角原则和穹隆原则。采用t检验、χ2 检验比较两组患者通道建立时间、手术时间、术后无石率、并发症发生率、术后住院时间的差异。结果两组患者一般情况的差异无统计学意义（P值均〉O．05）。对照组和SVOF组的首个通道建立时间[（16．5±8．4）min比（11．2±5．9）min，t=3．931，P=0．013]、一期结石清除率（74．3％比85．7％，χ2=16．868，P=0．000）、术后住院时间[（6．4±2．1）d比（4．8±1．8）d，t=4．574，P=0．000]、输血率（7．1％比2．9％，χ2=8．027，P=0．006）、选择性肾动脉栓塞率（3．3％与1．O％，χ2=5．390，P=0．020）的差异均有统计学意义。两组患者的手术时间、总结石清除率、术后发热和严重感染发生率差异无统计学意义（P值均〉0．05），无周围器官损伤等严重并发症和死亡病例。结论超声引导下SVOF原则两步穿刺法建立经皮肾镜工作通道，选盏定位快速、结石清除率高、并发症少、患者恢复快，具有较好的临床应用价值。

Objective To evaluate the safety and effectiveness of ultrasound-guided pereutaneous nephrolithotomy （PCNL） accessed by SVOF-prineiple and two-step puncture techniques. Methods A total of 838 cases with upper urinary stones underwent percutaneous nephrolithotomy successfully accessed by ultrasound-guided between June 2007 and December 2015 at Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. Of all cases were divided in two groups ： hydronephrosis calyces puncture group include 425 cases and SVOF-principle puncture group include 413 cases. The access establishment time, operation time, stone free rate （SFR）, postoperative complications, and postoperative hospitalization time between the two groups we compared by t test or χ2 test. Results Statistically significant differences were observed between hydronephrosis calyces puncture group and SVOF- principle puncturegroup in the first access establishment time （ （ 16.5 ＋ 8.4 ） minutes vs. （ 11.2 ± 5.9） minutes, t=3.931, P=0. O13）, one-stage SFR （74.3% vs. 85.7%, χ2 = 16.868, P= 0.000）, postoperative hospitalization time （ （ 6. 4 ± 2. 1 ） days vs. （ 4. 8 ± 1.8 ） days, t = 4. 574, P ---- 0. 000 ）, transfusion rate （7. 1% vs. 2. 9%, X2=8. 027, P=0. 006） , and embolization rate （3.3% vs. 1.0%, χ2= 5. 390, P = 0. 020）. There were no statistically significant differences in ooeration time. total SFR.postoperative fever and sever infection between these two groups （ all P〉 O. 05）. In both two groups, no serious complications such as peripheral organ injury and death occurred. Conclusions PCNL accessed guided by ultrasound with SVOF-principle and two-step puncture techniques has advantages of quick puncture location, high stone free rate, fewer complications and fast recovery. This technique is an effective and safe treatment option for upper urinary stones and deserved promotion and application in clinic.