两种标准双通道穿刺在经皮肾镜取石术治疗肾多发结石中的应用比较

Comparison of two standard double-channel punctures in percutaneous nephrolithotomy for treatment of multiple renal stones

目的比较可视化精准穿刺与常规穿刺标准双通道经皮肾镜取石术(PCNL)治疗肾多发结石的临床疗效.方法分析2017年7月-2018年8月该科88例行标准双通道PCNL治疗肾多发性结石的患者的临床资料,随机分为两组:可视化精准穿刺标准双通道组(n=40)与常规穿刺标准双通道组(n=48),比较两组在建立第一通道、第二通道时间、手术时间、血红蛋白下降值、术后输血率、一期结石清除率及住院时间等指标.结果两组第一通道建立时间[(2.53±1.52)vs(4.83±1.82)min,t=6.32,P=0.000]、第二通道建立时间[(3.02±2.54)vs(6.92±4.81)min,t=7.42,P=0.000]、手术时间[(65.46±15.54)vs(80.32±13.62)min,t=26.64,P=0.000]、血红蛋白下降值[(9.21±2.52)vs(13.22±3.53)g/L,t=3.02,P=0.000]、术后输血率[5.00%(2/40)vs 8.33%(4/48),χ^2=0.01,P=0.001]、一期结石清除率[85.00%(34/40)vs 81.25%(39/48),χ^2=3.21,P=0.008]和住院时间[(5.52±1.02)vs(7.63±1.21)d,t=0.61,P=0.001]差异均有统计学意义.结论可视化精准穿刺标准双通道与常规穿刺标准双通道PCNL在治疗肾多发结石中相比,前者具有缩短通道建立时间、缩短手术时间、减少出血、提高一期清石率和缩短住院时间等优点,使临床穿刺操作更加安全精准.

Objective To compare the clinical efficacy of two-channel percutaneous nephrolithotomy (PCNL) for multiple kidney stones, which is a standard of visual precise puncture and conventional puncture. Methods 88 cases of renal multiple calculi treated with standard double-channel PCNL from July 2017 to August 2018 were analyzed. They were randomly divided into two groups: visual precision puncture standard double-channel group (n = 40) and conventional puncture standard double-channel group (n = 48). The time of establishing the first and second channels, operation time and the rate of hemoglobin decrease and postoperative blood transfusion rate, primary stone clearance rate and hospitalization timewere compared between the two groups. Results The establishment time of the first channel [(2.53 ± 1.52) vs (4.83 ± 1.82) min, t = 6.32, P = 0.000], the establishment time of the second channel [(3.02 ± 2.54) vs (6.92 ± 4.81) min, t = 7.42, P = 0.000], the operation time [(65.46 ± 15.54) vs (80.32 ± 13.62) min, t = 26.64, P = 0.000], and the decrease value of hemoglobin in the two group [(9.21 ± 2.52) vs (13.22 ± 3.53) g/L, t = 3.02, P = 0.000], postoperative blood transfusion rate [5.00%(2/40) vs 8.33%(4/48),χ^2 = 0.01, P = 0.001], primary stone clearance rate [85.00%(34/40) vs 81.25%(39/48),χ^2 = 3.21,P = 0.008], hospital stay [(5.52 ± 1.02) vs.(7.63 ± 1.21) d, t = 0.61, P = 0.001], the differences were statistically significant. Conclusion Compared with the conventional PCNL, the visualized precise puncture standard doublechannel PCNL has the advantages of shortening the establishment time of the channel, shortening the operation time, reducing bleeding, high primary stone clearance rate and shortening the hospitalization time, which makes the clinical puncture operation safer and more accurate.