直视下双导丝扩张法:一种建立经皮肾通道的新方式  

Endoscopic dilation guided by two guidewires:a novel method in establishing channels in percutaneous nephrolithotomy

作　　者：窦全亮[1] 周六化[1] 李荣飞 刘敬宇 秦志强[1] 许露伟[1] DOU Quanliang;ZHOU Liuhua;LI Rongfei;LIU Jingyu;QIN Zhiqiang;XU Luwei(Department of Urology,Nanjing First Hospital,Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)泌尿外科,江苏南京210006

出　　处：《现代泌尿外科杂志》2023年第11期980-983,共4页Journal of Modern Urology

摘　　要：目的探讨采用“直视下双导丝扩张法”建立经皮肾通道的安全性和有效性。方法回顾性分析南京医科大学附属南京医院泌尿外科2020年10月—2022年10月收治的180例诊断为肾及输尿管上段结石并行经皮肾镜碎石术患者的临床资料。根据建立经皮肾通道的不同方式分为3组:60例患者采用逐级筋膜扩张法(AMD组),60例患者采用一步扩张法(OSD组),60例患者采用直视下双导丝扩张法(END组)。比较3组患者在通道建立时间、手术时间、通道扩张失败率、结石清除率、血红蛋白浓度下降值、肾动脉栓塞率、发热情况、输血情况、术后住院时间的差异。结果3组患者一般情况的差异无统计学意义(P>0.05)。与AMD组、OSD组相比,END组患者建立首个通道所需时间明显减少[(5.6±0.8)min vs.(4.9±1.4)min vs.(4.2±0.5)min,P<0.05]。与OSD组相比,END组、AMD组围手术期血色素下降值明显减少[(14.0±17.6)g·L^(-1)vs.(19.4±12.6)g·L^(-1)vs.(10.2±6.8)g·L^(-1),P<0.05]。3组患者在通道扩张失败率、手术时间、结石清除率、肾动脉栓塞率、发热情况、输血情况、术后住院时间方面的差异无统计学意义。4例患者需要选择性肾动脉栓塞止血(AMD组1例,OSD组3例),所有患者均未出现脏器损伤、感染性休克、死亡等严重并发症。结论采用“直视下双导丝扩张法”建立经皮肾通道,操作简单、并发症少,具有较好的临床应用价值。Objective To explore the safety and efficacy of a novel endoscopic two-wire guided dilation in the creation of channels in percutaneous nephrolithotomy(PCNL).Methods Clinical records of 180 patients undergoing PCNL during Oct.2020 and Oct.2022 were retrospectively analyzed.The patients were divided into three groups,60 in AMD group(fascial amplatz dilation),60 in OSD group(one shot dilation)and 60 in END group(endoscopic dilation).Time to establish channels,operating time,failure of access,stone clearance rate,drop in hemoglobin,embolization rate,fever rate,blood transfusion rate and postoperative hospitalization were compared among the three groups.Results There were no significant differences in the general data among the three groups(P>0.05).Compared with AMD and OSD groups,END group needed significantly reduced time to establish the first channel[(5.6±0.8)min vs.(4.9±1.4)min vs.(4.2±0.5)min,(P<0.05)].Compared with OSD group,END and AMD groups had significantly more hemoglobin drop[(14.0±17.6)g/L vs.(19.4±12.6)g/L vs.(10.2±6.8)g/L,(P<0.05)].There were no significant differences in terms of failure of establishing channels,operating time,stone clearance rate,embolization rate,fever rate,blood transfusion rate and postoperative hospitality.Four patients needed selective renal artery embolization(1 case in AMD group and 3 in OSD group).No serious complications such as organ injuries,septic shock or death occurred.Conclusion Endoscopic two-wire guided dilation is simple,with few complications and good application value.

关 键 词：尿路结石 肾造口术 经皮肾通道 内镜直视扩张 逐级筋膜扩张 一步扩张法 

分 类 号：R615[医药卫生—外科学]