完全超声引导与超声结合X线引导下球囊扩张经皮肾镜手术的安全性和有效性  

Study on the safety and effectiveness of complete ultrasound-guided and ultrasound-guided percutaneous renal balloon dilatation

作　　者：高立印 王艳波[1] 王春喜[1] Gao Liyin;Wang Yanbo;Wang Chunxi(Department of Urology,First Hospital of Jilin University,Changchun 130021,China)

机构地区：[1]吉林大学第一医院泌尿外一科,长春130021

出　　处：《中华泌尿外科杂志》2024年第2期114-117,共4页Chinese Journal of Urology

摘　　要：目的比较完全超声引导下球囊扩张法经皮肾镜取石术(PCNL)与超声结合X线引导下球囊扩张法PCNL的安全性和有效性。方法回顾性分析吉林大学第一医院2015年5月至2022年5月收治的992例肾结石患者的临床资料,患者均行球囊扩张法PCNL,引导方式分别为完全超声引导(完全超声组)和超声结合X线引导(超声结合X线组)。完全超声组395例,超声结合X线组597例,两组的性别(男/女:208/187例与329/268例)、年龄[(43.2±11.8)岁与(42.8±12.5)岁]、体质量指数[(22.8±2.6)kg/m^(2)与(22.6±3.1)kg/m^(2)]、美国麻醉医师协会分级[Ⅰ/Ⅱ/Ⅲ级:174/189/32例与277/273/47例]、结石侧别(左/右:207/188例与302/295例)、结石Guy's分级[Ⅰ/Ⅱ/Ⅲ/Ⅳ级:56/115/141/83例与88/198/209/102例]、结石长径[(4.7±0.9)cm与(4.8±1.1)cm]、肾积水程度[无/轻度/中度/重度:75/162/103/55例与88/266/175/58例]、既往经皮肾镜手术史[39例与45例]的差异均无统计学意义(P>0.05)。所有患者均全麻下行球囊扩张法PCNL,患者均取俯卧位。完全超声组仅采用超声实时监测穿刺和扩张的整个过程。超声结合X线组在实时超声引导下进行穿刺,同时通过X线监测穿刺和扩张过程。两组术后均常规留置双J管和肾造瘘管。比较两组的穿刺成功率、扩张成功率、手术时间、结石清除率和术后并发症。结果完全超声组和超声结合X线组的手术时间分别为(58.2±11.5)min和(61.1±10.8)min(P=0.43);穿刺成功率均为100.0%,一次扩张成功率分别为95.9%(379/395)和95.8%(572/597)(P=0.92)。完全超声组72例(18.2%)和超声结合X线组102例(17.1%)术中建立≥2个通道(P=0.64)。完全超声组和超声结合X线组的术后即刻结石清除率分别为88.9%(351/359)和90.0%(537/597)(P=0.58);术后住院时间分别为(4.2±1.1)d和(4.3±1.2)d(P=0.68)。完全超声组和超声结合X线组Clavien-DindoⅠ级(一过性发热分别为27例和40例,P=0.93)、Ⅱ级(输血分别为7例和11例,P=0Objective To compare the safety and effectiveness of percutaneous nephrolithotomy(PCNL)using complete ultrasound guided balloon dilation and ultrasound combined with X-ray guided balloon dilation.Methods A retrospective analysis was conducted on the clinical data of 992 patients with kidney stones admitted to the First Hospital of Jilin University from May 2015 to May 2022 who underwent balloon dilation PCNL.According to dfferent surgical methods,they were divided into complete ultrasound guided PCNL(complete ultrasound group)and ultrasound combined with X-ray guided PCNL(ultrasound combined with X-ray group),with 395 cases in the complete ultrasound group and 597 cases in the ultrasound combined with X-ray group.Gender of patients in the complete ultrasound group and ultrasound combined with X-ray group[male/female:208/187 cases and 329/268 cases],age[(43.2±11.8)years and(42.8±12.5)years],body mass index[(22.8±2.6)kg/m^(2)and(22.6±3.1)kg/m^(2)],ASA score[1/2/3:174/189/32 cases and 277/273/47 cases],location of stones(left/right:207/188 cases and 302/295 cases),Guy's score[Ⅰ/Ⅱ/Ⅲ/Ⅳ:56/115/141/83 cases and 88/198/209/102 cases],length of stones[(4.7±0.9)cm and(4.8±1.1)cm],the degree of hydronephrosis[no/mild/moderate/severe:75/162/103/55 cases and 88/266/175/58 cases]and the previous history of percutaneous kidney surgery[39 cases and 45 cases]were not significantly different(P>0.05).All patients underwent balloon dilation PCNL under general anesthesia,and were placed in a prone position.The complete ultrasound group only underwent real-time ultrasound monitoring of the entire process of puncture and dilation,without X-ray monitoring.The ultrasound combined with X-ray group performed puncture under real-time ultrasound guidance,while monitoring the puncture and dilation process by X-ray.Two groups underwent routine indwelling of double J tubes and nephrostomy tubes after surgery.The puncture success rate,dilation success rate,surgical time,stone clearance rate,and postoperative complications were comp

关 键 词：肾结石 经皮肾镜取石术 超声 X线 穿刺 扩张 

分 类 号：R699.2[医药卫生—泌尿科学]