超声造影引导下经皮肾镜取石工作通道建立的研究

Study on establishment of working channel for percutaneous nephrolithotomy guided by contrast-enhanced ultrasound

目的评估在经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)中,超声造影引导下工作通道建立的优势。方法选择2019年7月至2021年1月收治住院的60例无肾积水或者轻度肾积水的肾结石或输尿管上段结石患者,随机分成A组(即超声造影引导下经皮肾镜取石工作通道建立)及B组(即普通超声引导下经皮肾镜取石工作通道建立)各30例,两组均在超声定位下徒手进行目标肾盏穿刺,使用一次性微创扩张引流套件进行经皮肾盏扩张,放置一次性剥皮鞘,详细记录同一初学手术者在两组手术过程中穿刺针数、穿刺时间、手术时间、手术中出血量和手术前后血红蛋白量、感染率、肾周围器官损伤、肾造瘘管尿漏等数据。结果A组穿刺次数少于B组(P<0.01)。两组出血量、术前及术后HGB的比较差异均无统计学意义(P>0.05)。A组穿刺时间短于B组(P<0.01)。两组手术时间比较差异无统计学意义(P>0.05)。治疗期间,两组患者均无感染、脏器损伤、尿漏等情况发生。结论相对于普通超声引导下PCNL工作通道的建立,利用超声造影剂逆行肾盂造影可以改善PCNL术中肾集合系统显像情况,能更快更准确地进行目标盏组穿刺,更有利于经皮肾穿刺建立工作通道,使PCNL更安全、有效,手术并发症少,降低手术风险。

Objective To evaluate the advantages of working channel establishment guided by contrast-enhanced ultrasound during percutaneous nephrolithotomy(PCNL).Methods 60 hospitalized patients with renal calculi or upper ureteral calculi without hydronephrosis or mild hydronephrosis were selected from July 2019 to January 2021.All patients were randomly divided into group A(establishment of percutaneous nephrolithotomy working channel guided by contrast-enhanced ultrasound)and group B(establishment of percutaneous nephrolithotomy working channel guided by ordinary ultrasound),with 30 cases in each group.In both groups,the target renal calices were punctured by hand under ultrasonic positioning,the percutaneous renal calyceal dilatation was performed with a disposable minimally invasive dilatation and drainage kit,and a disposable peeling sheath was placed.And then,data of the times of puncture needles,puncture time,operation time,amount of bleeding during operation performed by the same surgical beginner in the two groups as well as hemoglobin before and after operation,infection rate,damage of organs around the kidney and urinary leakage of nephrostomy tube were recorded in detail.Results The times of puncture in the group A were less than those in the group B(P<0.01).There was no statistically significant difference in bleeding volume,preoperative and postoperative HGB between the two groups(P>0.05).The puncture time in the group A was shorter than that in the group B(P<0.01).There was no statistically significant difference in operation time between the two groups(P>0.05).During treatment,there was no infection,organ injury and urinary leakage in both groups.Conclusion In the establishment of the working channel of PCNL under the guidance of ordinary ultrasound,to improve renal collecting system imaging during PCNL by retrograde pyelography with ultrasound contrast agent can perform the target calyceal group puncture more quickly and accurately,which is more conducive to the establishment of working channel for percutaneous renal puncture,making PCNL safer and more effective,and reducing surgical complications and surgical risks.