“四步法”建立标准通道在经皮肾镜碎石取石术中的应用效果

Application of "four-step method" to establish standard channel in percutaneous nephrolithotomy

目的探讨"四步法"建立标准通道在经皮肾镜碎石取石术中的应用效果。方法回顾性分析2016年8月至2018年4月在重庆陆军军医大学新桥医院泌尿外科行经皮肾镜碎石取石术的92例患者的病例资料,按治疗方法分为对照组和观察组,每组各46例。对照组患者给予常规的标准通道碎石术治疗,观察组患者实施"四步法"建立标准通道取石术治疗。观察并比较两组患者的手术时间、术中出血量、术后相关指标、结石清除率以及并发症等指标。结果观察组患者的手术时间(60. 3±4. 3 min)、术中出血量(97. 3±11. 9 ml)均低于对照组(73. 1±3. 5 min,151. 2±12. 3ml),差异具有统计学意义(P <0. 05)。观察组患者的下床活动时间(33. 6±3. 2 h)、术后置管时间(5. 1±2. 3 d)和住院时间(12. 6±3. 0 d)均低于对照组(53. 1±3. 5 h,8. 6±1. 5 d,19. 3±3. 6 d),差异具有统计学意义(P <0. 05)。观察组患者的结石清除率(91. 3%)明显高于对照组(80. 4%),差异具有统计学意义(P <0. 05)。观察组患者的并发症发生率(6. 5%)明显低于对照组(21. 7%),差异具有统计学意义(P <0. 05)。结论 "四步法"建立标准通道在经皮肾镜碎石取石术中的应用效果显著,能够减少术中出血量、置管时间和住院时间,提高结石的清除率,减少并发症的发生,安全、有效,值得在临床上推广应用。

Objective To explore the application effect of "four-step method" to establish standard access in percutaneous nephrolithotomy. Methods 92 patients treated with percutaneous nephrolithotomy in the Department of Urology,Xinqiao Hospital,Chongqing Military Medical University from August 2016 to April 2018 were retrospectively analyzed. They were divided into control group and observation group according to the treatment methods,with 46 cases in each group. The control group were treated with routine standard channel lithotripsy,while the observation group were treated with " four-step" method to establish standard channel lithotripsy. The operation time,intraoperative bleeding volume,postoperative related indicators,stone clearance rate and complications between the two groups were observed and compared. Results The operation time( 60. 3 ± 4. 3 min) and intraoperative bleeding volume( 97. 3 ± 11. 9 ml) in the observation group were lower than those in the control group( 73. 1 ± 3. 5 min,151. 2 ± 12. 3 ml),and the difference was statistically significant( P < 0. 05). The time of getting out of bed( 33. 6 ±3. 2 h),postoperative catheterization time( 5. 1 ± 2. 3 d) and hospital stay( 12. 6 ± 3. 0 d) of observation group were lower than those of control group( 53. 1 ± 3. 5 h,8. 6 ± 1. 5 d,19. 3 ± 3. 6 d),and the difference was statistically significant( P < 0. 05). The stone clearance rate of the observation group( 91. 3%) was significantly higher than that of the control group( 80. 4%),the difference was statistically significant( P <0. 05). The incidence of complications in the observation group( 6. 5%) was statistically significant lower than that in the control group( P <0. 05). Conclusion The application of " four-step method" in percutaneous nephrolithotomy has a remarkable effect. It can reduce the amount of bleeding,reduce the time of catheterization and hospitalization of patients,improve the stone clearance rate and reduce the incidence of related complications. It has a certain degree of safety,effective and is worth popularizing in clinic.