F16和F20通道经皮肾镜碎石取石术治疗1.5~2.5 cm上尿路结石疗效与安全性比较  

A single center prospective study on the management of 1.5-2.5 cm upper urinary tract stones by minimally invasive percutaneous nephrolithotomy with different sizes

作　　者：熊庄 戚宇诚 余伟民[1] 阮远[1] 夏煜琦 林方优 李柏均 饶婷[1] 程帆[1] Xiong Zhuang;Qi Yucheng;Yu Weimin;Ruan Yuan;Xia Yuqi;Lin Fangyou;Li Bojun;Rao Ting;Cheng Fan(Department of Urology,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院泌尿外科,430060

出　　处：《中华实验外科杂志》2022年第1期146-149,共4页Chinese Journal of Experimental Surgery

基　　金：湖北省重点研发计划项目(2020BCB017)。

摘　　要：目的比较F16和F20通道治疗1.5~2.5 cm单发上尿路结石的效率与安全性。方法前瞻性分析武汉大学人民医院2018年12月到2020年12月满足纳入标准的138例行单通道经皮肾镜碎石取石术患者资料。其中14例患者根据排除标准被剔除研究,最终124例患者被纳入研究,F16组61例,F20组63例,所有患者均经目标盏"穹窿-盏颈"轴线进行穿刺,穿刺前行彩色多普勒超声判断,37例患者拟定穿刺路径上存在明显血管,F16组17例,F20组20例,采取避开血管的目标盏"穹窿侧边-盏颈"轴线穿刺路径,根据分组建立相应通道,利用钬激光粉碎结石。采用独立样本t检验、χ2检验或Fisher确切概率法比较两组患者一般情况、结石特征、术中术后指标的差异,线性回归分析手术时间与影响因素的相关性。结果两组患者术后血红蛋白下降,差异无统计学意义[(9.2±10.0)g/L比(8.9±8.2)g/L,t=0.207,P>0.05],且均未出现术中术后出血,两组患者在手术时间的差异有统计学意义[(39.2±5.1)min比(34.6±6.2)min,t=4.564,P<0.05],两组患者手术时间与结石CT值显著相关(F16,R=0.424;F20,R=0.664,P<0.01),F16组手术时间与结石直径相关(R=0.274,P<0.05),F20组手术时间与结石直径无明显相关(R=0.121,P>0.05)。结论F20通道相比F16通道,在处理结石时所用时间更短,效率更高,并可减少感染的风险。Objective To compare the efficacy of F16 and F20 tracts in the management of 1.5-2.5 cm single upper urinary tract stones.Methods The data of 138 patients who underwent single-tract percutaneous nephrolithotomy in our hospital from December 2018 to December 2020 who met the inclusion criteria were collected.Among them,14 patients were excluded from the study according to the exclusion criteria.Finally,124 patients were included in the study.There were 61 patients in the F16 group and 63 in the F20 group.All patients were punctured through the"fornix-calyx neck"axis of the target calyx.After the target puncture path was selected,color Doppler ultrasound was performed before the puncture.A total of 37 patients had obvious blood vessels on the planned puncture path,17 cases in F16 group and 20 in F20 group.The puncture path through the"fornix side-calyx neck"axis of the target calyx that avoided the blood vessel was adopted for them.Then the tracts were established according to the group.Holmium laser was used to remove the stones.The independent-samples Test,Chi-Square Test or Fisher’s exact test was used to compare the differences in patients’characteristics,stone characteristics,intraoperative and postoperative indicators between the two groups,and linear regression analysis was used to verify the correlation between operation time and influencing factors.Results There was no significant difference in postoperative hemoglobin reduction between the two groups[(9.2±10.0)g/L vs.(8.9±8.2)g/L,t=0.207,P>0.05],and there was no intraoperative and postoperative bleeding.The difference in operation time between the two groups was statistically significant[(39.2±5.1)min vs.(34.6±6.2)min,t=4.564,P<0.05].The operation time of the two groups was significantly related to the CT value of stones(F16:R=0.424;F20:R=0.664,P<0.01).The operation time in the F16 group was related to the diameter of the stone(R=0.274,P<0.05),and there was no significant correlation between the operation time and the diameter of the stone in the

关 键 词：上尿路结石 出血 融合肾锥体 

分 类 号：R699.2[医药卫生—泌尿科学]