B超引导下经皮肾镜取石术中穿刺成功率的临床研究  

Clinical study of the puncture success rate during ultrasound-guided percutaneous nephrolithotomy

作　　者：黄挺 程跃[1,2] 谢国海[1,2] 袁鹤胜[1,2] 胡嘉盛[1,2] 朱佳 奇方立 Huang Ting;Cheng Yue;Xie Guohai;Yuan Hesheng;Hu Jiasheng;Zhu Jiaqi;Fang Li(Department of Urology,Ningbo First Hospital,Ningbo 315010,China;Huang Ting is the graduated student o f Medical College of Ningbo University,Ningbo 315211,China)

机构地区：[1]宁波市第一医院泌尿肾病中心泌尿外科,315010 [2]黄挺为宁波大学医学院研究生,315211

出　　处：《中华泌尿外科杂志》2019年第12期923-926,共4页Chinese Journal of Urology

摘　　要：目的分析B超引导下经皮肾镜取石术(PCNL)中的穿刺成功率,并探讨穿刺失误原因。方法回顾性分析宁波市第一医院2018年8—11月收治的58例行传统B超引导下PCNL患者的临床资料。男36例,女22例;年龄22~73岁,平均51岁;结石直径9~93 mm,平均26.5 mm;肾脏集合系统分离5~30 mm,平均15.1 mm。58例均行一期PCNL,由4名有丰富PCNL经验(手术经验>10年,手术例数>80例/年)的泌尿外科医生手术。术中B超图像显示穿刺入目标肾盏后,将穿刺针针芯拔出,可见肾盏内尿液流出,定义为穿刺成功;若穿刺后无尿液流出,则定义为穿刺失误。统计并分析术中穿刺针数、手术通道数、穿刺失误原因等。结果58例均在B超引导下一期成功建立经皮肾通道,共穿刺118针,穿刺成功74针,建立手术通道68个(其中通道扩张失败6例),总体穿刺成功率为62.7%(74/118)。穿刺成功针数中,第1针即穿刺成功占比为56.8%(42/74),第2针穿刺成功占比为28.4%(21/74),第3针及以上穿刺成功占比为14.9%(11/74)。4名主刀医生穿刺成功率分别为59.2%(29/49)、64.1%(25/39)、66.7%(16/24)、66.7%(4/6),差异无统计学意义(P=0.679)。平均每个手术通道穿刺1.7针。穿刺失误针数共44针,其中穿刺针道偏移20例,穿刺针进入目标肾盏但拔出针芯后无尿液流出17例(具体穿刺失误原因不清,可能为穿刺过深或过浅,或穿刺针抵住结石),B超图像中穿刺针道显示不清7例。建立的68个通道中,33个通道未放置肾造瘘管,留置的35根肾造瘘管中,5根放置部位与术中预计穿刺盏不符,占14.3%(5/35)。术后7例出现ClavienⅠ级并发症,其中疼痛4例,发热(体温≥38.0℃)3例,予药物对症治疗后好转;1例出现ClavienⅡ级以上并发症,为气胸,予胸腔闭式引流后好转。结论B超引导下PCNL术中穿刺成功率不令人满意,穿刺失误原因主要为针道偏移、针道显示不清及其他可能原因(如穿刺过深或过浅,穿刺针抵住结石)。Objective To evaluate the success rate during ultrasound-guided percutaneous nephrolithotomy(PCNL)and analyze the reasons of puncture failure.Methods A retrospective analysis was performed based on the data of 58 patients who underwent ultrasound-guided PCNL by 4 experienced urologists(10 years'experience of PCNL and more than 80 cases per year)in our center from August 2018 to November 2018.Of all the 58 patients,there were 36 males and 22 females(aged from 22 to 73 years)with the mean age of 51 years.The calculi ranged from 9 mm to 93 mm,with the average of 26.5 mm.The separation of renal collecting system ranged from 5 mm to 30 mm,with the average of 15.1 mm.All of the 58 patients underwent one-stage PCNL and the numbers of punctures,the numbers of percutaneous tubes and the reasons for failure were recorded.Results All percutaneous tubes and surgeries were established and done successfully.Of all the 118 punctures,74 punctures succeeded by detecting the urine and 68 surgery tracts were established(6 punctures failed because of the dilation).The total puncture success rate was 62.7%(74/118).Of the total 74 successful punctures,56.8%(42/74)succeeded at the first puncture,28.4%(21/74)succeeded at the second puncture and 14.9%(11/74)succeeded at least after three punctures.The success puncture rate of the 4 urologists were 59.2%(29/49),64.1%(25/39),66.7%(16/24),66.7%(4/6)respectively,and there were no statistical differences between the puncture success rates of the urologists(P=0.679).Each channel needed 1.7 punctures on average.Fouty-four punctures failed without detecting the urine,including 20 failed punctures because of the puncture tract deviation,17 punctures without seeing the urine after the core needle being removed,7 punctures no display on the ultrasound imagine.There were 33 punctures to be tubeless while other 35 indwelling the nephrostomy tubes.Five nephrostomy tubes'position were different with the preoperationally predicted position which means the discrepancy rate was 14.3%(5/35).One patient had

关 键 词：肾结石 经皮肾镜手术 穿刺 成功率 

分 类 号：R47[医药卫生—护理学]