标准通道与微通道在PCNL中的应用效果及对患者术后感染的影响

The effect of standard channel and microchannel in PCNL and its influence on postoperative infection

目的探讨标准通道与微通道在经皮肾镜取石术(PCNL)中的应用效果及对患者术后感染的影响。方法选取2015年11月～2016年12月接受治疗的肾结石患者100例,采用随机数表法分为标准通道组和微通道组各50例。微通道组采用筋膜扩张法建立F16通道;标准通道组采用球囊扩张法建立F24通道,比较两组患者手术相关指标,对比两组患者术后结石清除率、术中肾盂内压、术后发热率以及术后感染率,分析比较两组患者手术前后肾功能指标改善情况,记录术后一周患者肾功能转归情况。结果标准通道组的手术时间短于微通道组,术后出血量低于微通道组,术后标准通道组患者的住院时间短于微通道组(P<0.05);术后标准通道组患者结石清除率高于微通道组;标准通道组患者发热率、感染率均分别低于微通道组术后发热率、感染率(P<0.05);标准通道组术中肾盂内压低于微通道组(P<0.05);术后,两组患者的BUN、Scr肾功能指标与术前比较均有降低,且标准通道组低于微通道组(P<0.05);术后,标准通道组患者肾功能好转率高于微通道组(P<0.05)。结论给予肾结石患者标准通道进行经皮肾镜取石术治疗,可缩短手术时间,术中患者肾盂内压小,术后结石清除率高,感染率低,对患者肾功能影响小。

Objective To investigate the effect of standard channel and micro channel in PCNL(percutaneous nephrolithotomy)and its influence on postoperative infection.Methods 100 patients of renal calculi were selected from November 2015 to December 2016 in our hospital and randomly divided into standard channel group and micro channel group.The micro channel used fascia expansion method to establish the F16 standard channel.Channel group with balloon dilation method was established the F24 channel index between the two groups.The postoperative stone clearance rate,intraoperative intrapelvic pressure,rate of postoperative fever,postoperative infection rate,improve the situation of two groups were compared with postoperative renal function indexes before and after the recording and renal outcomes a week after surgery were observed.Results The operation time of standard channel group(44.23+5.89 min)wea shorter than that of the micro channel group(56.12+9.02 min).The postoperative bleeding volume of standard channel group(178.45 + 21.02 ml)was less than that of micro channel group(201.45+22.56 ml).The postoperative time of standard channel group was shorter that in the micro channel group(P<0.05).After the operation,the stone clearance rate of standard channel group(92%)was higher than that of the micro channel group(64%).The rate of patients with fever and infection rate of of standard channel group were lower than those in the micro channel group(P<0.05).The renal pelvis pressure of standard channel group was lower than that of the micro channel group(P<0.05).After operation,BUN and Scr of the two group were decreased.BUN and Scr of the standard channel group was lower than that of the micro channel group(P<0.05).The rate of functional improvement of the standard channel group(80%)was higher than that of micro channel group(40%)(P<0.05).Conclusion For patients with kidney stones standard,channel percutaneous nephrolithotomy can shorten the operation time,induce small renal pelvic pressure during operation,have high stone clearance rate,low infection rate and little effect on renal function.