一步扩张法标准通道和大通道建立技术在复杂性肾结石经皮肾镜取石术中的应用  

Application of one-step dilatation technique for standard or large size tract creation in PCNL procedure for complex renal calculi

作　　者：李文成[1] 杨雄[1] 潘峰[1] 汪良[1] 王振迪[1] 侯腾[1] 邢毅飞[1] 鞠文[1] 李兵[1] 章小平[1] 曾甫清[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院泌尿外科,武汉430022

出　　处：《临床泌尿外科杂志》2014年第10期898-902,905,共6页Journal of Clinical Urology

摘　　要：目的：本研究中,我们拟介绍＂一步扩张法标准通道建立技术＂和＂一步扩张法大通道建立技术＂,同时评估在经皮肾镜取石术（PCNL）中应用这两种通道建立技术的安全性和有效性。方法：回顾性研究2013年7月-2014年6月在我院采用＂一步扩张法标准通道建立技术＂和＂一步扩张法大通道建立技术＂PCNL治疗的52例多发性、铸型或鹿角形肾结石病例,按照术中建立的第一通道（主要通道）的大小分为两组,标准通道组（F22）29例,大通道组（F26）23例,两组患者所建立的辅助通道均为F22。比较两组患者第一通道的建立时间、总体手术时间、肾脏出血、总肾功能、通道扩张失败、集合系统穿孔等相关指标。结果：两组患者建立的所有取石通道均采用一步扩张法成功建立标准通道（F22）或大通道（F26）,无通道扩张失败者。标准通道组和大通道组平均第一通道建立时间分别为（1.9±0.3）min和（2.5±0.4）min（P〈0.01）,总手术时间分别为（45.2±22.6）min和（39.8±23.3）min（P〈0.01）,术前-术后血红蛋白（Hb）下降值分别为（0.5±0.8）g/dl和（0.7±0.7）g/dl（P〈0.01）,患者术中及术后无需输血治疗。两组患者中无发生集合系统穿孔者。结论：＂一步扩张法标准通道建立技术＂和＂一步扩张法大通道建立技术＂均为安全且有效的肾脏取石通道建立方法。在严格经肾盏穹窿沿肾盏颈管走行穿刺的前提下,PCNL手术中采用一步扩张法建立大通道（F26）与建立标准通道（F22）相比肾脏出血略有增多,患者均无需输血。复杂性肾结石患者采用大通道可以缩短手术时间,取石效率更高。Objective：To introduce initial experience of one-step dilatation technique for standard or large size tract creation and to evaluate the safety and efficacy of the novel two solutions for creating nephrostomy tracts for percutaneous nephrolithotomy（PCNL）.Method：In this retrospective study,medical records and videos of 52 patients who had undergone PCNL procedures with one-step dilatation technique for standard or large size tract creation at our institution from July 2013 to June 2014 were reviewed.According to the size of the first created tract on each patients,29 and 23cases with stag-horn calculi were taken as standard size tract group and large size tract group respectively.In both groups,the size of ancillary tracts that created subsequently,if necessary,were F22 uniformly.The first tract creation time,total operating time,renal hemorrhage,overall renal function,tract dilatation failure and collecting system perforation were compared between the two groups.Result：The standard size tract group had significantly shorter mean tract creation time（1.9±0.3）vs.（2.5±0.4）min（P〈 0.01）and lower mean decrease in hemoglobin concentration（0.5±0.8）vs.（0.7±0.7）g/dl（P〈 0.01）compared with large size tract group,respectively.There was a significant difference in mean total operating time between standard and large size tract groups（45.2±22.6）vs.（39.8±23.3）min（P〈 0.01）.There was no patient received blood transfusion therapy and no other major complications such as tract dilatation failure or collecting system perforation happened in both groups.Conclusion：The one-step dilatation techniques for standard（F22）and large（F26）size tract creation are both simple,safe and effective for creating nephrostomy tracts in PCNL procedures.Ifthe needle puncture was made strictly to go through the fornix and along the direction of the infundibulum,the creation of large size tract（F26）would not lead to more renal hemorrhage compared with the creation of standard size tract�

关 键 词：经皮肾镜取石术 一步扩张法 标准通道 大通道 安全性 

分 类 号：R692.4[医药卫生—泌尿科学]