无积水肾行经皮肾镜取石术两种皮肾通道建立方法的疗效比较

Efficacy comparison of two methods of establishing percutaneous renal channel in percutaneous nephrolithotomy without hydrocele

目的对照研究无积水肾行经皮肾镜取石术(PCNL)在皮肾通道建立过程中B超定位穿刺法(对照组)与组合式输尿管软镜的集成光学纤维束结合B超定位穿刺法(观察组)的有效性和安全性。方法前瞻性研究60例无积水肾PCNL手术过程,根据皮肾通道建立方法分成观察组、对照组。对照组30例,男18例,女12例;年龄24~62岁,平均(42±12)岁;结石负荷为460~2200mm^2,平均(940±220)mm^2;结石平扫CT值为480~1220Hu,平均(827±150)Hu。观察组30例,男21例,女9例;年龄27~70岁,平均(46±7)岁;结石负荷为524~2434mm^2,平均(1053±260)mm^2;结石平扫CT值为432~1109Hu,平均(867±139)Hu。观察两组在通道建立时间、穿刺次数、手术时间、术中出血量、保留造瘘管时间、术后并发症情况等方面的差别。结果60例手术均成功实施;在平均穿刺次数和通道建立时间方面,观察组明显优于对照组(P<0.05);而在手术时间、血色素降低水平及术后保留造瘘管时间方面,两组之间差异无显著性(P>0.05);并发症采用Clavien-Dindo分级法进行分级,在Ⅰ级并发症发生率方面,两组之间差异无统计学意义(P>0.05);在Ⅱ/Ⅲa级并发症发生率方面,观察组明显少于对照组(P<0.05);两组患者均没有发生Ⅲb及以上级并发症。结论集成光学纤维束结合B超定位穿刺建立皮肾通道的方法安全有效,与单纯B超定位穿刺法相比可以减少Clavien-Dindo II级及以上并发症的发生。

Objective To compare the effectiveness and safety of ultrasound localization puncture(control group)and a flexible microoptic system combined with ultrasound localization puncture(observation group)in percutaneous nephrolithotomy(PCNL)without hydrocele.Methods A prospective study was conducted on60 cases of PCNL without hydrocele.The control group included 18 males and 12 females,average age(42±12)(24~62)years,stone load(940±220)(460-2200)mm^2,and stone density(827±150)(480-1220)Hu.The observation group included21 males and9 females,average age(46±7)(27-70)years,stone load(1053±260)(524-2434)mm^2 and stone density(867±139)(432-1109)Hu.The time needed to establish channel,number of punctures,operation time,intraoperative blood loss,nephrostomy tube indwelling time and postoperative complications were compared between the two groups.Results All operations were successful.The observation group was significantly superior to the control group in terms of average number of punctures and time needed to establish channel(P<0.05).There were no significant differences between the two groups in operation time,hemoglobin reduction and nephrostomy tube indwelling time(P>0.05).Complications were graded by Clavien-Dindo grading method.There was no significant difference in the incidence of grade I complications between the two groups(P>0.05).The observation group had significantly lower incidence of gradeⅡ/Ⅲa complications than the control group(P<0.05).No complications of gradeⅢb or above occurred in either group.Conclusion It is safe and effective to establish a percutaneous renal channel by using a flexible microoptic system combined with ultrasound localization puncture.Compared with ultrasound localization puncture,this method can significantly reduce the incidence of gradeⅢb or above complications.