负压清石鞘在经皮肾镜治疗结石梗阻性脓肾中的应用

Application of percutaneous nephrolithotomy with ClearPetra negative pressure sheath in the treatment of obstructive calculous pyonephrosis

目的探讨经皮肾镜碎石取石术(PCNL)联合负压清石鞘(Clear Petra)治疗结石梗阻性脓肾的临床应用价值。方法将2016年3月至12月广州医科大学附属第五医院泌尿外科76例结石梗阻性脓肾行PCNL的患者随机分为两组,各38例。A组使用工作鞘(CREATE)结合双导管(Cyberwand)超声碎石,B组采用负压清石鞘(Clear Petra)结合气压弹道或钬激光碎石。结果两组患者均采用Ⅰ期手术方式。B组较A组一期结石清除率高(84.2%vs 63.1%,P=0.037)。最终结石清除率差异无统计学意义(94.4%vs 86.8%,P=0.43)。B组的手术时间,明显短于A组[(56±20) min vs (70±15) min,P=0.035)]。B组的总并发症发生率为15.8%,低于A组的23.7%。结论经皮肾镜联合负压清石鞘(ClearPetra)一期治疗结石梗阻性脓肾简便、安全、有效,值得临床推广。

Objective To investigate the clinical value of percutaneous nephrolithotomy(PCNL)combined with ClearPetra negative pressure sheath in the treatment of obstructive calculous pyonephrosis.Methods From March to December 2016,76 patients underwent PCNL in the Fifth Affiliated Hospital were randomly divided into two groups,38 cases in each group.Patients in group A were treated with CREATE combined with Cyberwand double probe ultrasound lithotripsy,and group B were treated with ClearPetra negative pressure stone sheath combined with pneumatic lithotripsy and/or holmium laser lithotripsy.Results All patients were treated withⅠstage operation successfully.Compared with group A,group B had a higher rate of stone removal(84.2%vs 63.1%,P=0.037).There was no significant difference in stone clearance(94.4%vs 86.8%,P=0.43).The operation time of group B,significantly shorter than that of group A at[(56±20)min vs(70±15)min,P=0.035].The complication rate of group B was lower than that of group A(15.8%vs 23.7%,P=0.035).Conclusion PCNL combined with ClearPetra negative pressure clear stone sheath is a simple,safe and effective,economical and practical method for the treatment of obstructive calculous pyonephrosis.