无积水或微积水肾结石经皮肾穿刺41例分析

Analysis of 41 cases of percutaneous renal puncture without hydrops or microhydrops

目的探讨可视经皮肾穿刺在无积水或微量积水肾结石中的应用价值。方法收集2019年12月至2021年12月无锡市第五人民医院与江苏省淮安市淮阴医院收治的41例无积水或微量积水肾结石患者的临床资料, 其中采用传统经皮肾穿刺20例(传统经皮肾穿刺组), 采用可视经皮肾穿刺21例(可视经皮肾穿刺组)。比较分析两组的单次穿刺成功率、单次建立皮肾通道成功率、导丝置入肾盂例数、穿刺并建立皮肾通道时间、形成假道例数等指标。结果传统经皮肾穿刺组行单通道取石16例, 双通道取石4例;可视经皮肾穿刺组行单通道取石16例, 双通道取石5例。两组通道数量比较, 差异无统计学意义(P>0.05);可视经皮肾穿刺组的单次穿刺成功率、单次建立皮肾通道成功率、导丝置入肾盂例数、穿刺并建立皮肾通道时间优于传统经皮肾穿刺组, 但差异均无统计学意义(均P>0.05)。传统经皮肾穿刺组形成假道的例数多于可视经皮肾穿刺组, 但差异无统计学意义(P>0.05)。结论可视经皮肾穿刺可以提高穿刺及建立皮肾通道的成功率, 增加手术安全性, 缩短术者的学习曲线。

Objective To investigate the application value of visual percutaneous renal puncture in the treatment of kidney stones without or with minimal hydrops.Methods A total of 41 patients with kidney stones without hydrops or trace hydrops were selected from the Fifth People's Hospital of Wuxi City and Huaiyin Hospital of Huaian City,Jiangsu Province from December 2019 to December 2021.Among them,20 patients were treated with traditional percutaneous kidney puncture(traditional percutaneous kidney puncture group)and 21 patients were treated with visual percutaneous kidney puncture(visual percutaneous kidney puncture group).The success rate of single puncture,the success rate of single establishment of cutaneous renal channel,the number of cases of renal pelvis insertion with guide wire,the time of puncture and establishment of cutaneous renal channel,and the number of cases of formation of false channel were compared between the two groups.Results In the traditional percutaneous renal puncture group,16 patients received single channel lithotomy and 4 patients received double channel lithotomy.In the visual percutaneous kidney puncture group,16 patients underwent single channel lithotomy and 5 patients underwent double channel lithotomy.There was no significant dfference in the number of channels between the two groups(P>0.05).There were no significant differences between the two groups in the success rate of single puncture,the success rate of single establishment of cutaneous renal channel,the number of renal pelvis insertion cases,and the time of puncture and establishment of cutaneous renal channel(all P>0.05).The number of cases forming false paths in the traditional percutaneous renal puncture group was higher than that in the visual percutaneous kidney puncture group,but the difference was not statistically significant(P>0.05).Conclusions Visual puncture could improve the success rate of puncture and the establishment of percutaneous renal channel,increase the safety of surgery,and shorten the learning curve of the operator.