肾盂低压并高效清石的增强版超微经皮肾镜技术  

Enhanced SMP(e SMP) technique: low renal pelvic pressure and high lithotripsy efficiency

作　　者：闻俊军 彭林杰 钟文[1] Wen Junjun;Peng Linjie;Zhong Wen(Department of Urology,the First Affiliated Hospital of Guangzhou Medical University,Guangdong Provincial Key Laboratory of Urology,Guangzhou Institute of Urology,Guangzhou 510230,China)

机构地区：[1]广州医科大学附属第一医院泌尿外科,广东省泌尿外科重点实验室,广州泌尿外科研究所,510230

出　　处：《中华腔镜泌尿外科杂志（电子版）》2021年第2期108-112,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：广州市科技计划项目珠江科技新星专项(201610010169);广州市教育局市属高校科研项目(1201620038)。

摘　　要：目的近年来超微经皮肾镜碎石取石术(SMP)技术飞速发展,逐步成熟,但14 F超微通道处理大负荷肾结石可能导致手术时间延长。我们在SMP基础上将灌注负压吸引鞘增大为18 F,以期提高碎石效率并保持肾盂内低压。本研究通过对比分析18 F增强版超微经皮肾镜碎石取石术(eSMP)与同为18 F通道的微创经皮肾镜碎石取石术(mPCNL)治疗2~5 cm肾结石的术中肾盂内压及取石效率等指标,验证eSMP技术的安全有效性。方法2017年1月至2019年12月,我院100例肾结石患者接受PCNL治疗,随机分入eSMP组和mPCNL组。建立18 F通道,eSMP组采用灌注吸引鞘,mPCNL组采用剥离鞘,分别用超微肾镜(11 F)和8/9.8 F输尿管镜,钬激光联合气压弹道碎石器碎石取石。术中监测肾盂内压,并记录手术时间、碎石时间、结石体积以及并发症等数据,进行统计学分析。结果mPCNL组与eSMP组取出结石体积差异无统计学意义,但mPCNL组碎石取石所耗时间显著长于eSMP组[(50.1±19.6)min vs(35.3±14.3)min,t=4.314,P<0.001],因而单位时间内eSMP取石更多[(13.66±1.17)mm3/h vs(9.78±1.23)mm3/h,t=16.150,P<0.001],且总的手术时间上mPCNL组相较eSMP组也显著延长[(67.3±19.5)min vs(52.1±14.4)min,t=4.429,P<0.001]。术中肾盂内压m PCNL组显著高于e SMP组[(17.88±3.28)mm Hg vs(12.01±2.45)mm Hg,t=10.140,P<0.001],mPCNL组术中肾盂内压>30 mmHg累计时间显著长于eSMP组[(23.2±16.6)s vs(3.8±4.3)s,t=8.012,P<0.001]。术后血红蛋白下降量mPCNL组较eSMP组更显著[(17.1±6.8)g/L vs(14.0±7.5)g/L,t=2.182,P=0.032]。两组患者术后发热率、结石清除率的差异均无统计学意义,但mPCNL组住院时间显著长于eSMP组[(2.98±0.87)d vs(2.60±0.78)d,t=2.298,P<0.001]。结论增强版SMP(eSMP)借助于灌注负压吸引鞘,相较传统mPCNL,能够提高碎石取石效率,并保持术中较低的肾盂内压,治疗2~5 cm肾结石是安全有效的。Objective In recent years,the super mini-PCNL(SMP)technique has developed rapidly and matured gradually.However,the operation time may be prolonged when manage the large burden renal calculi with 14 F tract.On the basis of SMP,the suction sheath was increased to 18 F,in the aim to improve the lithotripsy efficiency and keep a low renal pelvic pressure,which was called enhancedSMP(eSMP).In the present study,eSMP and mini-PCNL was compared to analyze the intra-operative renal pelvic pressure and stone removal efficiency when managed the 2-5 cm renal calculi,and to verify the safety and efficiency of e SMP technique.Methods From January 2017 to December 2019,100 patients with 2-5 cm renal calculi in our hospital were randomly divided into e SMP group and m PCNL group.18 F percutaneous tract was established,suction sheath with 11 F mini nephroscope and peel-away sheath with 8/9.8 F ureteroscope was used in e SMP and m PCNL,respectively.Ho:YAG laser and pneumatic lithotriptor was used for lithotripsy.During the operation,renal pelvic pressure was measured,operation time,lithotripsy time,removed stone volume and complications were recorded and analyzed statistically.Results There was no significant difference in the stone volume removed between m PCNL group and e SMP group,but the lithotripsy time in m PCNL was significantly longer than e SMP group[(50.1±19.6)min vs(35.3±14.3)min,t=4.314,P<0.001],thus the stone removal effectiveness was higher in e SMP group[(13.66±1.17)mm3/h vs(9.78±1.23)mm3/h,t=16.150,P<0.001],and the total operation time in m PCNL group was longer than e SMP group[(67.3±19.5)min vs(52.1±14.4)min,t=4.429,P<0.001].The intra-operative renal pelvic pressure in m PCNL group was higher than e SMP group[(17.88±3.28)mm Hg vs(12.01±2.45)mm Hg,t=10.140,P<0.001],and also the accumulated time of renal pelvic pressure>30 mm Hg in m PCNL group was longer than e SMP group[(23.2±16.6)s vs(3.8±4.3)s,t=8.012,P<0.001].The postoperative decreased hemoglobin in m PCNL group was more than e SMP group[(17.1±6.8

关 键 词：肾结石 经皮肾镜 肾盂内压 碎石效率 前瞻性研究 

分 类 号：R699.2[医药卫生—泌尿科学]