免人工肾积水在超声引导斜仰卧截石位经皮肾镜取石术中的应用

Application of no artificial hydronephrosis in percutaneous nephrolithotomy guided by ultrasound

目的探讨超声引导下斜仰卧截石位经皮肾镜取石术免除输尿管逆行插管制造人工肾积水的可行性和安全性。方法回顾性研究2018年1月~2019年12月在石家庄市人民医院接受经皮肾镜手术治疗的肾、输尿管上段结石伴肾积水患者247例,按手术方法将患者分为观察组(免人工肾积水)140例及对照组(人工肾积水)107例。将两组的结石清除率、围手术期参数及术后并发症进行分析、比较。结果两组患者年龄、性别、结石位置和结石负荷、肾积水直径等差异无统计学意义(P>0.05);所有病例均成功建立经皮肾通道,观察组在穿刺通道建立时间、术后血红蛋白下降幅度、一期手术清石率、术后住院天数与对照组比较,差异均无统计学意义(P>0.05);观察组一次穿刺成功率低于对照组,但手术时间明显短于对照组,差异有统计学意义(P=0.002);两组并发症发生率差异无统计学意义(P>0.05)。结论超声引导下斜仰卧截石位经皮肾镜取石术中免除人工肾积水治疗合并肾积水的肾、输尿管上段结石安全有效,方法更加简便易行。

Objective To explore the feasibility and safety of ultrasound-guided percutaneous nephrolithotomy in semisupine-lithotomy position without retrograde ureteral catheterization for artificial hydronephrosis.Methods from January 2018 to December 2019,247 cases of kidney and upper ureteral calculi with hydronephrosis were treated by percutaneous nephroscopy in our hospital.They were divided into 140 cases of experimental group(free hydronephrosis)and 107 cases of control group(hydronephrosis).The stone clearance rate,perioperative parameters and postoperative complications of the two groups were analyzed and compared.Results there was no significant difference in age,gender,stone position,stone load and hydronephrosis diameter between the two groups.All cases were successfully established percutaneous renal access.The experimental group had no significant difference in the establishment time of puncture access,the decrease of hemoglobin after operation,the stone removal rate of one-stage operation and the length of stay after operation compared with the control group.The success rate of one-time puncture in the experimental group was lower than that in the control group(P=0.038);the operation time in the experimental group was significantly shorter than that in the control group(P=0.002);there was no significant difference in the incidence of complications between the two groups(P=0.370).Conclusion it is safe and effective to avoid artificial hydronephrosis in percutaneous nephrolithotomy with semisupine-lithotomy position under the guidance of ultrasound in the treatment of renal and upper ureteral calculi with hydronephrosis,and the method is more simple and easy,which is worthy of clinical promotion.