超声造影技术在非扩张肾脏集合系统肾结石患者经皮肾镜手术中的应用  

Contrast-enhanced ultrasound technique is used in percutaneous nephroscopic surgery in patients with nephrolithiasis in the collecting system of the undilated kidney

作　　者：陈海瑞 李寿鹏 田霁松 沈东来[1] 王威[1] 罗渝昆[3] 李秋洋[3] 张旭[1] 麦海星[1,2] Chen Hairui;Li Shoupeng;Tian Jisong;Shen Donglai;Wang Wei;Luo Yukun;Li Qiuyang;Zhang Xu;MΛai Haizing(Department of Urology,the Third Medical Center,PLA General Hospital,Beijing 100039,China;The Fifth Clinical Medical College of Anhui Medical University,Hefei 230032,China;Department of Ultrasound Diagnosis,the First Medical Center,PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第三医学中心泌尿外科医学部,北京100039 [2]安徽医科大学第五临床医学院,合肥230032 [3]解放军总医院第一医学中心超声诊断科,北京100853

出　　处：《微创泌尿外科杂志》2024年第4期240-247,共8页Journal of Minimally Invasive Urology

基　　金：国家自然科学基金面上项目(82173259);北京市自然科学基金面上项目(7222232);北京市科技计划(Z221100007422123)。

摘　　要：目的:对比超声造影(CEUS)和常规超声引导下应用于非扩张肾脏集合系统肾结石患者的经皮肾镜取石术(PCNL),评估CEUS引导的PCNL的有效性、安全性和可行性。方法:研究纳入解放军总医院第一医学中心收治接受PCNL的66例无肾积水或轻度肾积水肾结石患者,根据通道建立引导方法的不同分为CEUS引导组(33例)和常规超声引导组(33例)。评估单针穿刺成功率、穿刺时间、穿刺次数、通道建立时间、手术时间、残石率等指标及术后并发症发生情况。采用SPSS22.0统计软件进行统计学分析。结果:相比于常规超声引导组,CEUS引导组首次穿刺成功率高(84.85%vs.63.64%,χ^(2)=3.89,P=0.04)、穿刺时间短[(51.18±18.47)s vs.(63.21±23.79)s,t=-2.29,P=0.03]、手术时间短[(73.81±39.84)minvs.(113.44±51.99)min,t=-3.46,P<0.01],差异均有统计学意义。两组1个月残石率、血红蛋白(Hb)下降幅度以及穿刺次数比较,差异均无统计学意义(均P>0.05)。结论:CEUS引导下的PCNL可促进无肾积水患者的PCNL,有利于单针穿刺成功率高,穿刺时间短,手术时间短。可通过后续大样本量研究进一步确定其临床推广价值。Objective:To compare contrast-enhanced ultrasound(CEUS)and conventional ultrasound-guided percutaneous nephrolithotomy(PCNL)in patients with non-dilated collecting system kidney stones,evaluate the effectiveness,safety,and feasibility of CEUS-guided PCNL in the First Medical Center of PLA General Hospital.Methods:This study included 66 patients with no hydronephrosis or mild hydronephrosis who underwent PCNL,they were divided into CEUS-guided group(33 cases)and conventional ultrasound-guided group(33 cases)according to the different methods to establish channel.The first puncture success rate,puncture time,puncture times,channel establishment time,operation time,residual stone rate and postoperative complications were evaluated.SPSS 22.0 statistical software was used for statistical analysis.Results:Compared with the conventional ultrasoundguided group,the CEUS-guided group had a higher first puncture success rate(84.85%vs.63.64%,χ^(2)=3.89,P=0.04),shorter puncture time[(51.18±18.47)s vs.(63.21±23.79)s,t=-2.29,P=0.03],and shorter operation time[(73.81±39.84)min vs.(113.44±51.99)min,t=-3.46,P<0.01],with statistically significant differences.The 1-month stone residue rate,the decrease of hemoglobin(Hb)and puncture times had no statistically significant differences(all P>0.05).Conclusion:CEUS-guided PCNL facilitates percutaneous nephrolithotomy in patients without hydronephrosis,leading to a higher success rate of single puncture,shorter puncture time,and reduced overall surgery time.Future large-scale studies are needed to confirm its value for broader clinical application.

关 键 词：超声造影 经皮肾镜 免人工肾积水 激光碎石取石 

分 类 号：R699.2[医药卫生—泌尿科学]