20F通道与18F通道经皮肾镜碎石术的临床疗效及安全性比较  

Comparison of clinical efficacy and safety of 20F and 18F tract percutaneous nephrolithotomy

作　　者：冯杰 陈文炜 叶华 甘晶 曹超 毛厚平 Feng jie;Chen Wenwei;Ye Hua;Gan Jing;Cao Chao;Mao Houping(Department of Urology,the Third People's Hospital of Fujian University of Chinese Medicine,Fuzhou,Fujian 350108,China;Department of Urology,the First Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian 350005,China)

机构地区：[1]福建中医药大学附属第三人民医院泌尿外科,福建福州350108 [2]福建医科大学附属第一医院泌尿外科,福建福州350005

出　　处：《泌尿外科杂志（电子版）》2024年第2期28-34,共7页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的探讨20F通道与18F通道经皮肾镜碎石术(percutaneous nephrolithotripsy,PCNL)的临床疗效及安全性。方法采用前瞻性随机对照研究,选取2021年4月至2022年4月于福建医科大学附属第一医院收治的200例行微创PCNL患者作为研究对象,根据掷骰法结合随机数字表法分为20F通道组与18F通道组,每组100例。比较两组手术时间、结石清除率、穿刺部位、通道数量、视觉模拟评分法(visual analogue scale,VAS)评分、住院时间、Clavien-Dindo分级系统的并发症。结果本研究最终纳入患者174例,18F通道组81例,20F通道组93例。两组性别、年龄、体质量指数、肾手术史、术前尿培养、肾小球滤过率、结石侧别、结石数量、鹿角型结石、累计肾盏、结石成分、结石大小、结石CT值、结石评分比较,差异均无统计学意义(P>0.05)。两组手术时间比较,差异有统计学意义(P<0.05);两组穿刺位置、通道数量、血红蛋白变化、结石清除率、Clavien分级并发症、24 h后VAS评分、术后住院天数比较,差异均无统计学意义(P>0.05)。对于结石>4 cm的患者,20F通道组和18F通道组手术时间比较,差异有统计学意义(P<0.05);两组通道数量、结石数量、结石评分、手术时间、结石清除率、血红蛋白变化、24 h后VAS评分、住院天数、Clavien分级比较,差异均无统计学意义(P>0.05);对于结石≤4 cm的患者,两组各项指标比较,差异均无统计学意义(P>0.05)。结论20F通道与18F通道PCNL比较,对于结石长径≤4 cm的患者,推荐选择18F通道;对于结石长径>4 cm的患者,推荐选择20F通道,其手术时间更短,效率更高。Objective To investigate the clinical efficacy and safety of 20F tract and 18F tract percutaneous nephrolithotomy(PNCL).Methods A prospective randomized controlled study was conducted to select200 patients underwent minimally invasive percutaneous nephrolithotomy who were admitted to the First Affiliated Hospital of Fujian Medical University from April 2021 to April 2022,and the patients were divided into 20F tract group and 18F tract group according to dice rolling method combined with random number table method,with 100 cases in each group.The operating time,stone clearance rate,puncture site,number of tracts,visual analogue scale(VAS),hospitalization periods,and complications of Clavien-Dindo classification system between the two groups were compared.Results A total of 174patients were ultimately included,with 81 in the 18F tract group and 93 in the 20F tract group.There was no statistically significant difference between the two groups in gender,age,body mass index,urological treatment,preoperative urine culture,glomerular filtration rate,laterality of stone,number of stones,staghorn-type stones,stone location,stone composition,stone size,CT value of stones,and stone score(P>0.05).The operating time between the two groups was statistically different(P<0.05).There was no statistically significant difference between the two groups in puncture site,number of tracts,haemoglobin drop,stone clearance rate,Clavien-indo,VAS-24 h,postoperative hospitalization(P>0.05).For patients with stones>4 cm,the difference in operation time between the 20F tract group and the 18F tract group is statistically significant(P<0.05);there was no statistically significant difference between the two groups in puncture site,number of tracts,haemoglobin drop,stone clearance rate,Clavien-indo,VAS-24 h,postoperative hospitalization(P>0.05).For patients with stones≤4 cm,there was no statistically significant difference in various indicators between the two groups(P>0.05).Conclusions Comparing 20F tract PCNL with 18F tract PCNL,18F tract is

关 键 词：经皮肾镜碎石术 肾结石 结石清除率 通道 

分 类 号：R692.4[医药卫生—泌尿科学]