不同孔径通道PCNL治疗输尿管上段结石的疗效和安全性分析

Efficacy and Safety of Percutaneous Nephrolithotomy with Different Apertures in Treatment of Upper Ureteral Calculi

目的比较不同孔径通道经皮肾镜取石术(PCNL)治疗输尿管上段结石的疗效和安全性。方法将上海交通大学医学院附属第九人民医院2013年10月至2018年2月收治的78例拟行PCNL治疗的输尿管上段结石患者按随机数字法分为标准通道组、微通道组,各39例。标准通道组术中通道扩张至24 F建立经皮肾通道、置入20.8 F肾镜,微通道组术中通道扩张至16 F建立经皮肾通道、置入9.8 F输尿管镜。比较两组患者的手术情况(手术时间、术中出血量)、恢复情况[血红蛋白下降值、住院时间、术后4 h舒适度评分(BCS)、术后4 h视觉模拟评分法(VAS)评分]、并发症(输血率、发热率)发生情况等,以及两种不同孔径通道PCNL治疗输尿管上段结石的疗效。结果微通道组患者的术中出血量低于标准通道组[(2.2±0.6) m L比(12.3±2.0) m L](P<0.01)。微通道组患者术后4 h BCS高于标准通道组[(2.96±0.17)分比(1.56±0.39)分],VAS评分低于标准通道组[(4.0±0.7)分比(7.0±1.3)分](P<0.01)。标准通道组的输血率、发热率分别为7.69%(3/39)、12.82%(5/39),微通道组分别为5.13%(2/39)、15.38%(6/39),两组患者的术后并发症发生率比较差异无统计学意义(P>0.05)。两组患者的一期手术成功率均为100%(39/39),术后1周、1个月、3个月的结石清除率比较差异无统计学意义(P>0.05)。结论标准通道与微通道两种不同孔径PCNL治疗输尿管上段结石的疗效与安全性相似,但微通道PCNL在减少术中出血量、提高术后舒适度、降低术后疼痛方面有积极意义。

Objective To compare the efficacy and safety of percutaneous nephrolithotomy(PCNL) with different apertures in the treatment of upper ureteral calculi.Methods A total of 78 patients with upper ureteral calculi treated with PCNL in Shanghai Ninth People’s Hospital,Shanghai Jiaotong University School of Medicine from Oct.2013 to Feb.2018 were randomly divided into a standard channel group and a microchannel group,39 cases in each group.In the standard channel group,percutaneous renal access was established by expanding to 24 F to implant a 20.8 F nephroscope.In the microchannel group,percutaneous renal access was established by expanding to 16 F to implant a 9.8 F ureteroscope.The operation conditions(operation time,intraoperative bleeding volume),recovery[hemoglobin decline,hospitalization time,bruggrmann comfort scale(BCS) 4 hours after operation,visual analogue scale(VAS) score 4 hours after operation],complications(transfusion rate,fever rate) and efficacy of PCNL with two different aperture channels of the two groups were compared.Results The intraoperative bleeding volume in the microchannel group patients were lower than that in the standard channel group[(2.2±0.6) m L vs(12.3±2.0) m L](P<0.01).The BCS 4 hours after operation of the microchannel group was higher than that in the standard channel group[(2.96±0.17) scores vs(1.56±0.39) scores],and the VAS score 4 hours after operation of the microchannel group were lower than that in the standard channel group[(4.0±0.7) scores vs(7.0±1.3) scores](P<0.01).The transfusion rate and fever rate were 7.69%(3/39) and 12.82%(5/39) in the standard channel group and 5.13%(2/39) and 15.38%(6/39) in the microchannel group respectively.There was no significant difference in the incidence of complications between the two groups(P>0.05).The success rate of one-stage operation in both groups was 100%(39/39).There was no significant difference in stone clearance rate between the two groups at 1 week,1 month and 3 months after operation(P>0.05).Conclusion The efficacy and safety of PCNL with standard and microchannel apertures in the treatment of upper ureteral calculi are similar,but microchannel PCNL has better performance in reducing intraoperative bleeding,improving postoperative comfort and reducing postoperative pain.