超声与X线引导下经皮肾镜取石术治疗儿童复杂性肾结石的疗效及安全性比较

Comparison of efficacy and safety of percutaneous nephrolithotomy under ultrasonic versus X-ray guidance for complicated renal calculi in children

目的比较超声与X线引导下经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗儿童复杂性肾结石的疗效及安全性。方法回顾性分析2011年7月至2018年7月国家儿童医学中心复旦大学附属儿科医院使用PCNL治疗的80侧儿童复杂性肾结石的临床资料,其中经X线引导41侧,经超声引导39侧。对两组病例术前一般情况以及一次穿刺皮肾通道建立成功率、穿刺失败例数、术中及术后并发症发生例数、结石清除率等指标进行比较分析。结果两组病例年龄、左右侧别及结石大小方面的差异均无统计学意义(P>0.05)。术中经超声引导组在一次皮肾通道建立成功率上优于经X线引导组(89.7%vs.70.7%,P=0.034)。经X线引导组中,2侧最终穿刺失败终止手术,1侧并发结肠损伤,2侧围手术期输血。两组病例在最终穿刺失败例数(2 vs.0)、平均手术时间[(109.76±32.46)min vs.(109.26±74.68)min]、术中并发症(1 vs.0)、围手术期输血(2 vs.0)、平均术后住院天数[(8.49±2.72)min vs.(8.23±1.78 d)min]、结石清除率(80.5%vs.76.9%)方面差异均无统计学意义(P>0.05)。结论超声引导下PCNL在治疗小儿复杂性肾结石中同样安全、有效,相比传统的X线引导,完全避免了医患在PCNL手术中的放射线暴露,值得临床推广。

Objective To compare the efficacy and safety of percutaneous nephrolithotomy(PCNL)under ultrasonic versus X-ray guidance for complicated renal calculi in children.Methods From July 2011 to July 2018,clinical data were retrospectively analyzed for 80 sides with complicated renal calculi undergoing PCNL,including 41 sides guided by X-ray and 39 sides guided by ultrasound.Preoperative general profiles,success rate of one-time skin-kidney channel establishment,number of failed puncture cases,perioperative complications and stone free rate(SFR)were compared.Results No significant inter-group difference existed in gender,age,sideness or stone size(P>0.05).Intraoperative ultrasound group was significantly better than X-ray group in success rate of one-time skin-kidney channel establishment(89.7%vs 70.7%,P=0.034).In X-ray group,2 sides failed in the final puncture for terminating operation,1 side had concurrent colon injury and 2 sides received perioperative blood transfusion.In two groups(X-ray/ultrasound),no statistically significant differences existed(P>0.05)in number of final puncture failure(2 vs 0),average operative duration(109.76±32.46 vs 109.26±74.68 min),intraoperative complications(1 vs 0),perioperative period blood transfusion(2 vs 0),average postoperative hospital stay(8.49±2.72 vs 8.23±1.78 d)or SFR(80.5%vs 76.9%).Conclusion PCNL guided by ultrasound is as safe and effective as guided by traditional X-ray for complicated renal calculi in children.Capable of completely avoiding the radiation exposure of surgeons and patients during PCNL surgery,it is worthy of further clinical popularization.