一款新式凝血电极在标准通道经皮肾镜取石术中的应用

Application of a novel coagulate electrode in standard percutaneous nephrolithotomy

目的:总结采用一款新式凝血电极在标准通道经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)中的临床应用情况,评估其在手术辅助方面中的安全性和有效性。方法:回顾性分析我院2018年3月-2019年10月收治的126例上尿路结石患者的临床资料。男76例,女50例;年龄23-76岁,平均54.9岁;左侧62例,右侧64例。所有患者均接受了完全超声定位下标准单通道PCNL。其中采用新式电极进行通道止血患者79例(新式电极组),传统电极进行手术通道止血患者47例(传统电极组)。收集两组患者围手术期相关参数进行比较,观察两组患者在手术时间、结石清除率、通道数目、术后出血量、住院时间等方面有无差异。结果:采用新式电极组术后血红蛋白下降值平均为(6.9±0.3) g/L,低于传统电极组(13.0±0.2) g/L,两组比较差异有统计学意义(P=0.03)。新式电极组术后平均住院时间为(4.3±0.5) d,传统电极组术后平均住院时间为(5.2±0.4) d,两组比较差异有统计学意义(P=0.02)。两组结石清除率比较差异无统计学意义(82%vs.79%,P>0.05)。两组在手术时间、通道数目等方面未见明显差异。结论:我们研发的新款肾镜下凝血电极具有良好的减少PCNL术后出血,促进患者快速康复的临床效果。

Objective: To describe and introduce a novel electrode in standard percutaneous nephrolithotomy(PCNL), evaluate its safety and feasibility in the surgery. Method: From Mar. 2018 to Oct. 2019, 126 upper urinary tract stone patients were collected and retrospectively analyzed, including 76 males and 50 females, whose average age was 54.9(23-76) years old. Stones were found in 62 cases on the left side while 64 cases on the right side. All patients received standard single access PCNL under total ultrasonography. The novel electrode was used in 79 cases, while the other cases were not. The perioperative parameters were collected in the two groups. Operative duration, stone clearance, number of access, blood loss and hospital stay were analyzed and compared. Result: Blood loss in novel electrode group was significant lower than that in the traditional homemade electrode group [(6.9±0.3) g/L vs.(13.0±0.2) g/L, P=0.03]. Hospital stay decreased significantly compared with traditional group [(4.3±0.5) d vs.(5.2±0.4) d, P=0.02]. However, the remarkable difference was not seen in stone-free rate(82% vs. 79%, P>0.05). Also, operative duration, number of access and other parameters showed no significant difference. Conclusion: The new designed electrode can effectively decrease the blood loss volume and promote fast recovery in standard access PCNL.