等离子双极电切电凝系统在经皮肾镜碎石术中的直接止血作用

Direct Hemostatic Effect of Plasma Bipolar Electrocoagulation System in Percutaneous Nephrolithotomy

目的探讨等离子双极电切电凝系统在经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)中的直接止血作用。方法2017年11月~2019年3月我院在78例PCNL术中肾镜直视下观察出血点,柱状电极头端顶住出血点通过电凝(功率40 W,一般每个出血点电凝时间约10 s)快速止血。结果本组78例均一期穿刺成功并建立皮肾通道碎石,4例建立双通道,无中转开放手术及术中、术后不可控制的大出血。手术时间50~120 min,(75.5±12.5)min;止血时间3~15 min,(6±2)min。无术中、术后输血。术后复查KUB,68例无结石残留或无临床意义残留结石;10例结石残留或结石位于平行盏,术后行体外震波碎石,其中5例自行排出碎石,3例经原通道行二期PCNL,2例重建通道行PCNL。78例随访4~6个月,平均4.8月,无并发症发生,无肾、输尿管结石复发。结论等离子双极电切电凝系统应用于PCNL术中止血是一种安全可行、简单有效的方法。

Objective To assess the direct hemostatic effect of plasma bipolar electrocoagulation system in percutaneous nephrolithotomy(PCNL).Methods The clinical data of 78 cases of hemostasis during PCNL in our hospital from November 2017 to March 2019 were retrospectively analyzed.All the patients had different degrees of bleeding during the operation,and accurate electrocoagulation was performed on the bleeding points by using the plasma cylindrical electrode tip(power 40 W).The electrocoagulation time for each bleeding point took about 10 s.Results Percutaneous renal access tract for PCNL were successfully established in the 78 patients,and two tracts were established in 4 patients.There was no transition to open surgery or uncontrolled bleeding intraoperatively and postoperatively.The operation time was 50-120 minutes,with an average of(75.5±12.5)minutes.The hemostasis time was 3-15 minutes,with an average of(6±2)minutes.No blood transfusion was needed intraoperatively and postoperatively.Postoperative re-examination of KUB showed that 68 patients had no residual calculi or clinically insignificant residual fragments.The calculi remained or were located in parallel calyces in 10 cases.Extracorporeal shock wave lithotripsy was performed postoperatively.The stones were discharged by themselves in 5 cases,and 3 cases underwent second-stage PCNL through the original channel,and 2 cases underwent PCNL through the reconstructed channel.There was no complication or recurrence of kidney and ureteral stones in the 78 patients after 4-6 months’follow-ups(average,4.8 months).Conclusion Plasma bipolar electrocoagulation system is a safe,feasible,simple and effective method for hemostasis in PCNL.