新型止血内鞘在无管化经皮肾镜中的临床应用

The clinical application of a kind of innovative hemostatic sheath in tubeless percutaneous nephrolithotomy

目的通过使用新型止血内鞘对皮肾通道内的出血点进行电凝止血,提高无管化经皮肾镜的安全性。方法回顾性分析了2015年7月至2020年6月无管化经皮肾镜手术患者586例的临床资料。在经皮肾镜碎石结束后常规检查通道,使用自行设计的新型止血内鞘对通道内的明显止血点进行电凝止血。分析通道止血病例的手术时间、止血时间、术后血红蛋白的下降、输血率、肾动脉栓塞比例等临床资料。结果586例无管化经皮肾镜中,103例在通道检查时发现有明显出血点,予止血鞘止血后不留置肾造瘘管。通道止血的病例其经皮肾镜碎石手术时间53~105 min,通道止血时间7~19 min。术后次日血红蛋白下降7~21 g/L,平均14 g/L,术后2 d血红蛋白下降11~32 g/L,平均19 g/L。术后无输血或肾动脉栓塞发生。术后2周结石清石率94.5%(554/586)。2例少量肾脏包膜下血肿,6例少量患侧胸腔积液,均经保守治疗痊愈。结论常规皮肾通道检查,使用新型止血内鞘进行电凝止血,可以减少无管化经皮肾镜的术后出血,减少输血及肾动脉栓塞的发生,提高无管化经皮肾镜的安全性。

Objective To improve the safety of tubeless percutaneous nephrolithotomy by using a kind of innovative hemostatic sheath to electrocoagulate the bleeding in the percutaneous renal channel.Method The clinical data of 586 patients with tubeless percutaneous nephrolithotomy from July 2015 to June 2020 were retrospectively analyzed.After finishing the process of percutaneous nephrolithotomy,the self-designed innovative hemostatic sheath was used to electrocoagulate the bleeding found in the percutaneous renal channel by routine check.The operation time,hemostasis time,decrease of hemoglobin after operation,blood transfusion rate and renal artery embolism ratio were analyzed.Result In 586 cases of tubeless percutaneous nephrolithotomy,103 cases were found to have obvious bleeding in the percutaneous renal channel.The self-designed innovative hemostatic sheath was used to electrocoagulate the bleeding and no nephrostomy tube was left.The operation time of percutaneous nephrolithotomy was 53-105 minutes and the hemostasis time was 7-19 minutes.After operation,hemoglobin decreased 7-21 g/L(average 14 g/L)on the next day and decreased 11-32 g/L(average 19 g/L)2 days later.No blood transfusion or renal artery embolism occurred.The stone removal rate was 94.5%(554/586)2 weeks after operation.There were 2 cases of renal subcapsular hematoma and 6 cases of pleural effusion,all cured by conservative treatment.Conclusion Routine channel examination and electrocoagulation by innovative hemostatic sheath can reduce postoperative bleeding,blood transfusion and renal artery embolism,and improve the safety of tubeless percutaneous nephrolithotomy.