输尿管镜直视法建立经皮肾通道的安全性及有效性分析

Safety and efficiency of establishing channels during percutaneous nephrolithotomy under ureteroscopic vision

摘要:

目的：探讨“输尿管镜直视法”应用于经皮肾通道建立中的安全性及有效性。方法：回顾性研究2014年1月至2017年6月重庆医科大学附属第一医院的325例经皮肾镜碎石取石术（percutaneous nephrolithotomy，PCNL）病例，均为B超引导下行经皮肾通道建立，其中169例采用“输尿管镜直视法”建立经皮肾通道，156例为未采用输尿管镜直视法建立经皮肾通道。统计2组病例性别、年龄、体质指数（body mass index，BMI）、既往手术史等术前基本资料和S.T.O.N.E.结石评分，并统计一次建立通道成功率、建立通道时间、建立通道相关并发症、术后并发症、手术时间和血红蛋白（hemoglobin，HB）变化，分析“输尿管镜直视法”应用于经皮肾通道建立的优势。结果：2组手术均顺利实施。其中直视法组一次性建立通道成功率（100％）明显高于对照组（94.9%），且具有统计学差异（P<0.05），直视法组建立通道时间为（10.5±2.4） min、术前术后HB变化为（11.15±5.99） g/L，均小于对照组且对比差异有统计学意义（P<0.05）。统计并比较2组术中通道丢失、穿刺过深、穿入血管、通道大出血、肾盏颈损伤几个方面通道相关并发症，直视法组通道相关并发症明显少于对照组，具有统计学意义（P<0.05）。统计2组患者Clavien-Dindo术后并发症分级，直视法组在Ⅲ级以上方面并发症明显少于对照组，且具有统计学意义（P<0.05）。结论：输尿管镜直视法用于经皮肾通道建立中便于手术的顺利实施，并提高经皮肾手术安全性及有效性。

Abstract:

Objective：To evaluate the safety and efficiency of ureteroscopic vision method applying in establishing channel during percutaneous nephrolithotomy（PCNL）. Methods：A retrospective study had been done including totally 325 percutaneous nephrolitho-tomy operations from January 2014 to June 2017 in the First Affiliated Hospital of Chongqing Medical University. All channels of PCNL were established under the guidance of ultrasound，of which 169 cases were operated using the ureteroscopic vision method to establish PCNL channel，while the other 156 cases did not. The sex，age，BMI，prior surgery and the S.T.O.N.E nephrolithometry score were compared before the operation between two groups. And channel establishment time，channel primary success rate，operation time，the amount of bleeding，and the channel related complication were compared between two groups. Results：The patients in both groups were successfully implemented PCNL. There were statistically significant differences in channel primary success rate，channel establi-shment time，and the amount of bleeding during operation between two groups（100% vs. 94.9%，（10.5±2.4） min vs. （16.4±2.6） min，（11.15±5.99） g/L vs. （17.05±9.42） g/L；P<0.05）. Complications related to channel establishment，including loss of channel，excessive puncture，vascular damage，massive hemorrhage，calyx neck injury were compared between two groups；those in experimental group was significantly lower than those in control group. The post-operation complications were classified and compared，according to Clavien-Dindo system，the complications above grade Ⅲ were statistically significant lower in experimental group than in control group. Conclusion：The safety and efficiency of percutaneous nephrolithotomy can make improvement with ureteroscopic vision method.