等离子柱状电极对经皮肾镜术中肾实质出血点止血效果的随机对照研究  

Clinical efficacy of cauterization of renal parenchyma bleeding points in percutaneous nephrolithotomy with pluse cylidrical electrode : a randomized controlled trial study

作　　者：贾灵华[1] 胡美迪[2] 熊星[1] 包佑根[1] 王金根[1] Jia Linhua Hu Meidi Xiong Xin Bao Yougen Wang Jingen(Department of Urology, Jiangxi Pronvincial People＇s Hospital, Nanchang 330006, China Department of Gerontology, the Firity Affiliated Hospital of Nanchang University, Nanchang 330006, China)

机构地区：[1]江西省人民医院泌尿外科,南昌330006 [2]南昌大学第一附属医院老年内科,330006

出　　处：《中华腔镜泌尿外科杂志（电子版）》2016年第6期23-27,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：江西省卫生厅普通计划(20155025)

摘　　要：目的通过前瞻性随机对照研究探讨经皮肾镜术中(PCNL)使用等离子柱状电极对经皮肾通道的肾实质出血点进行电凝止血的疗效。方法 2013年7月至2014年12月江西省人民医院泌尿外科因上尿路结石行PCNL的病例中,60例观察到肾实质明确出血点,以此60例患者为研究对象,将其随机分为2组,实验组(30例)术中用等离子柱状电极对出血点电凝止血,对照组(30例)出血点不予电凝止血,其余处理两组均按通常做法留置肾造瘘管,使用相同止血药物。术后连续72 h收集每24 h全部尿液,拔除肾造瘘管后再收集24 h全部尿液,用氰化高铁血红蛋白法测定24 h尿液中血红蛋白浓度并根据尿量计算出24 h尿液中的血红蛋白总量,以此作为术后出血量的指标。使用两个独立样本t检验的统计学方法分析两组出血量的差异。结果两组患者术中及术后均未出现大出血。术后第一个24 h实验组平均丢失的血红蛋白量,明显低于对照组,差异有统计学意义[(4.6±0.8)g vs(7.8±1.8)g,P<0.01];术后第二个24 h实验组平均丢失的血红蛋白量明显低于对照组,差异有统计学意义[(1.5±0.6)g vs(4.0±1.7)g,P<0.05];术后第三个24 h实验组平均丢失的血红蛋白量略低于对照组,但差异无统计学意义[0.15(0.10)g vs 0.24(0.12)g,P>0.05];拔除肾造瘘管后24小时实验组平均丢失的血红蛋白量明显低于对照组,差异有统计学意义[(1.2±0.6)g vs(3.4±1.2)g,P<0.05];观察窗口期内实验组平均丢失的血红蛋白总量明显低于对照组,差异有显著的统计学意义[(7.5±1.9)g vs(15.4±4.3)g,P<0.01]。对照组2例患者拔除肾造瘘管后出现一过性肉眼血尿,经保守治疗后血尿消失。结论对于PCNL术中肾实质小出血点,术后均能自行止血,但是术中用等离子柱状电极对出血点进行电凝止血能明显减少术后出血量,尤其能明显减少术后第一天和拔除肾造瘘管后24 h内的失血量。Objective To perform a perspective randomized controlled study to assess the coagulating efficacy and safety of cauterization of access tract hemorrhagic spots in percutaneous nephrolithotomy with pluse cylindrical electrode. Methods No patient required transarterial embolization to control the hemorrhage. A total of 60 percutaneous nephrolithotomies, which were discovered hemorrhagic spots in the access tract, were performed at the department of Urology in Jiangxi Provincial People＇s Hospital from July 2013 to December 2014. The patients were divided randomly into the experimental group and the controlled group. In the experimental group （n=30）, cauterization of access tract hemorrhagic spots with pluse cylindrical electrode was performed. But in the controlled group （n=30）, no procession wasperformed. The drainage fluid for 24 hours from the nephrostomy tube and the catheter was collected continually in three following days after the operation and another 24 hours after removing the nephrostomy tube. And the total amount of hemoglobin in the drainage fluid was evaluated with the method of Cyanide Methemoglobin. T test was used on two independent samples to analyze the differences of the amount of bleeding. Results The average loss of hemoglobin in the experimental group was lower than controlled group during the first 24 h of postoperation [（4.6±0.8） g vs （7.8±1.8） g, P〈0.01]. The average loss of hemoglobin in the experimental group was lower in the controlled group from 24 h to 48h of postoperation [（1.5±0.6） g vs （4.0±1.7） g, P〈0.05]. The average loss of hemoglobin in the experimental group was lower in the controlled group from 48 h to 72 h of postoperation [0.15 （0.10） g vs 0.24 （0.12） g, P〉0.05]. The average loss of hemoglobin in the experimental group was lower the controlled group in the first 24 h after removing the nephrostomy tube [（1.2±0.6） g vs （3.4±1.2） g, P〈0.05）]. The totally average loss of hemoglobin in the experimental group was signif

关 键 词：肾造口术  经皮 出血 止血 随机对照研究 

分 类 号：R699[医药卫生—泌尿科学]