预穿刺在多通道经皮肾镜碎石取石术中的应用价值探讨  

The application value of pre-puncture in multi-channel percutaneous nephrolithotomy

作　　者：包鹏飞 吴琦[2] 张会江[2] 潘昊[1] BAO Pengfei;WU Qi;ZHANG Huijiang;PAN Hao(Department of Urology,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Department of Urology,Lishui People’s Hospital,Lishui 323000,China)

机构地区：[1]浙江大学医学院附属第一医院泌尿外科,浙江杭州310016 [2]丽水市人民医院泌尿外科,浙江丽水323000

出　　处：《健康研究》2023年第2期212-216,共5页Health Research

基　　金：丽水市浙大合作项目(2018ZDHZ12);浙江省基础公益研究计划项目(LGF20H050003);浙江省医药卫生科技计划项目(2020382934);浙江省中医药科技计划项目(2020ZB309)。

摘　　要：目的探讨通过多通道预穿刺提高一期经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)的安全性及清石率。方法择期行多通道PCNL治疗的复杂性肾结石患者92例随机分为常规穿刺组和预穿刺组各46例,预穿刺组采用碎石前预穿刺成功留置多根导丝并固定,根据通道碎石要求按需启用预置导丝建立多个经皮肾通道碎石,比较两组一期多通道建立成功率、结石清除率、建立通道时间、手术输血及相关并发症发生情况。结果预穿刺组多通道建立成功率为97.3%,结石清除率为89.1%,均高于常规穿刺组(89.4%、71.7%),差异有统计学意义(χ^(2)=5.617、4.420,均P<0.05);预穿刺组的建立通道时间、输血例数及相关并发症发生率均低于常规穿刺组,差异有统计学意义(P<0.05)。结论预穿刺可以提高复杂性肾结石一期PCNL多通道建立成功率,增加通道建立的精准性与安全性,缩短建立通道时间,减少术后结石残留,降低出血及相关并发症。Objective To observe the safety and stone clearance rate of multi-channel pre-puncture in the first-stage percutaneous nephrolithotomy(PCNL)and to provide reference for preventing perioperative complications.Methods Ninety-two patients with complex kidney stones who underwent multi-channel PCNL were randomly divided into a conventional puncture group and a pre-puncture group(n=46 each).The pre-puncture group underwent successful pre-puncture and retention of multiple guide wires before stone fragmentation,and established multiple percutaneous renal access channels according to the channel fragmentation requirements.The two groups were compared in terms of the success rate of first-stage multi-channel establishment,stone clearance rate,time for establishing channels,transfusion rate,and related complications.Results The success rate of multi-channel establishment in the pre-puncture group was 97.3%,and the stone clearance rate was 89.1%,both of which were higher than those in the conventional puncture group(89.4%,71.7%),with statistical significance(χ^(2)=5.617,4.420,both P<0.05).The time for establishing channels,the number of transfusions,and the incidence of related complications in the pre-puncture group were lower than those in the conventional puncture group,with statistical significance(P<0.05).Conclusions Pre-puncture can improve the success rate of multi-channel establishment in the first-stage PCNL for complex kidney stones,increase the accuracy and safety of channel establishment,shorten the time for establishing channels,reduce residual stones after surgery,and reduce bleeding and related complications.

关 键 词：预穿刺 一期手术 多通道 经皮肾镜 复杂性肾结石 

分 类 号：R619.5[医药卫生—外科学]