超声引导经“肾椎体乳头-盏颈”穿刺在经皮肾镜碎石取石术中的安全性研究  

Application of ultrasound-guided puncture through the "renal vertebral papilla calyceal neck" axis in percutaneous nephrolithotripsy

作　　者：包鹏飞 叶俊杰 张会江[1] BAO Pengfei;YE Junjie;ZHANG Huijiang(Lishui People's Hospital,Zhejiang 323000,China)

机构地区：[1]浙江省丽水市人民医院,丽水323000

出　　处：《浙江创伤外科》2023年第10期1807-1810,共4页Zhejiang Journal of Traumatic Surgery

基　　金：浙江省医学会临床科研基金项目(2022ZYC-A107);丽水市公益性技术应用研究项目(2020GYX22,2023GYX60)。

摘　　要：目的 探讨通过超声引导经“肾椎体乳头-盏颈”轴线穿刺通路在经皮肾镜碎石取石术(PCNL)中的安全性。方法 选取2020年9月至2022年3月上尿路结石在本院行PCNL治疗的255例患者行回顾性分析,根据术中不同的穿刺引导,将141例经“肾盏穹窿-盏颈”轴线的设为对照组,114例经“肾椎体乳头-盏颈”轴线的设为观察组,比较两组术中出血量,围手术期失血量,输血及介入下止血治疗情况。结果 观察组患者术中出血量、术后24小时及3天时血红蛋白下降量均明显少于对照组,差异均有统计学意义(P<0.05)。观察组术后1周时复查血红蛋白下降量虽少于对照组,但差异无统计学意义(P>0.05)。对照组中3例输血及2例超选择肾动脉栓塞止血,观察组中均未予输血及肾动脉栓塞治疗。结论 PCNL术中运用超声引导经“肾椎体乳头-盏颈”轴线穿刺建立经皮肾通道是一项安全有效的技术,更精准的避开肾脏大血管,其对比当前公认穿刺路径具有术中及术后出血量更少,无明显出血并发症发生,值得临床推广应用。Objective To exploring the safety and bleeding incidence of percutaneous nephrolithotripsy(PCNL) guided by ultrasound through the puncture pathway of "renal vertebral papilla calyceal neck" axis.Methods 255 patients with upper urinary tract stones who underwent PCNL treatment in our hospital from September 2020 to March 2022 were retrospective analyzed.According to different intraoperative puncture guidance pathways,141 cases were set as the control group,who were through the "renal calyceal fornix neck" axis,and 114 cases were set as the observation group,who were through the "renal vertebral papilla calyceal neck" axis.The intraoperative bleeding volume,perioperative blood loss,blood transfu-sion,and interventional hemostasis treatment were compared between the two groups.Results The intraoperative bleeding volume and hemoglobin decrease at 24 hours and 3 days after surgery in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).Although the hemoglobin decrease in the observation group was less than that in the control group after 1 week of surgery,the difference was not statistically significant(P<0.05).In the control group,there were 3 cases of blood transfusion and 2 cases of superselective renal artery embolization for hemostasis,while in the observation group,no blood transfusion or renal artery embolization treatment was given.Conclusion The use of ultrasound guided puncture through the "renal vertebral papilla calyceal neck" axis during PCNL surgery to establish a per-cutaneous renal channel is a safe and effective technique,which more accurately avoids large renal vessels.Compared with currently recognized punc-ture pathways,it has less intraoperative and postoperative bleeding,no obvious bleeding complications,and is worthy of clinical promotion and appli-cation.

关 键 词：超声引导 “肾椎体乳头-盏颈”轴线 经皮肾镜 出血 

分 类 号：R699.2[医药卫生—泌尿科学]