经皮肾镜取石术中一步扩张法与顺序扩张法通道建立技术的对比研究

谢青松; 朱德浩; 付勇; 李靖冬; 李文成

doi:10.13201/j.issn.1001-1420.2017.09.013

经皮肾镜取石术中一步扩张法与顺序扩张法通道建立技术的对比研究

- 1 广水市中医院泌尿外科(湖北广水, 432700);
- 2 华中科技大学同济医学院附属协和医院泌尿外科(武汉, 430022)

详细信息

通讯作者: 李文成,E-mail:lwcnick@163.com

中图分类号: R692.4

收稿日期: 2017-07-10

Research on Chinese one-shot versus sequential fascial dilatation for creating nephrostomy tract for percutaneous nephrolithotomy

- 1 Department of Urology, Guangshui Traditional Chinese Medicine Hospital, Guangshui, Hubei, 432700, China;
- 2 Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Scienceand Technology

More Information

Corresponding author: LI Wencheng, E-mail: lwcnick@163.com

Received Date: 10 July 2017

摘要

摘要: 目的：本研究旨在评估和比较一步扩张法和顺序扩张法在经皮肾镜取石术（PCNL）中的安全性和有效性。方法：回顾性研究2012年1月~2016年12月在我院接受PCNL手术治疗的225例病例资料，其中采用顺序扩张法建立取石通道117例，采用一步扩张法建立取石通道108例。比较两组在通道建立时间、肾脏出血、肾功能、通道建立失败、集合系统穿孔等指标。结果：与顺序扩张法组相比，一步扩张法组通道建立时间更短[（2.5±0.5）min vs.（4.5±1.0）min，P<0.01]，术后血红蛋白下降值更低[（0.6±0.4）g/dl vs.（0.7±0.3）g/dl，P<0.01）]。两组病例在术前术后血清肌酐（Cr）变动值比较差异无统计学意义（P>0.05）。顺序扩张法组通道丢失2例，采用超声重新定位穿刺后建立取石通道；一步扩张法组无通道丢失病例。顺序扩张法组发生集合系统穿孔或对侧肾实质损伤各1例，一步扩张法组发生对侧肾实质损伤1例。结论：一步扩张法是一种简单、安全和有效的取石通道建立技术。与顺序扩张法相比，一步扩张法建立取石通道所需时间更短、术中术后出血量更少。
- 经皮肾镜取石术 /
- 一步扩张法 /
- 顺序扩张法 /
- 肾结石 /
- 并发症
Abstract: Objective: In this study, we present our initial experience of Chinese one-shot dilatation for creating nephrostomy tract for percutaneous nephrolithotomy (PCNL), and evaluate the safety and efficacy of this novel technique.Method: In this retrospective study, we enrolled 225 cases who underwent PCNL at our hospital from January 2012 to December 2016.The 117 and 108 patients underwent sequential fascial dilatation or Chinese oneshot dilatation technique for creating nephrostomy tract in PCNL procedure respectively.Tract creation time, renal hemorrhage, overall renal function, tract dilatation failure and collecting system perforation were compared between the two groups.Result: The Chinese one-shot group had a significantly shorter mean tract creation time[(2.5±0.5) min vs. (4.5±1.0) min, P<0.01]and lower mean decrease in hemoglobin concentration[(0.6±0.4) g/dl vs. (0.7±0.3) g/dl, P<0.01)]compared with sequential fascial dilatation group, respectively.In sequential dilatation group, dilatation failure occurred in two patients, collecting system perforation presented in one patient and renal parenchyma damage across the puncture site appeared in the other one patient.There was one patient experienced renal parenchyma damage across the puncture site and no dilatation failure or collecting system perforation presented in Chinese one-shot group.Conclusion: The one-shot nephrostomy tract dilatation technique is a simple, safe and efficacious technique for establishing percutaneous access tract.It renders less timeconsuming and less renal hemorrhage as compared with sequential fascial dilatation technique.
- percutaneous nephrolithotomy /
- Chinese one-shot /
- sequential dilatation /
- renal stone /
- complications

HTML全文

参考文献(9)

[1]	Tomaszewski J J, Smaldone M C, Schuster T, et al.Factors affecting blood loss during percutaneous nephrolithotomy using balloon dilation in a large contemporary series[J].J Endourol, 2010, 24 (2):207-211.
[2]	Yamaguchi A, Skolarikos A, Buchholz N P, et al.Clinical Research Office Of The Endourological Society Percutaneous Nephrolithotomy Study Group.Operating times and bleeding complications in percutaneous nephrolithotomy:a comparison of tract dilation methods in 5, 537 patients in the Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study[J].J Endourol, 2011, 25 (6):933-939.
[3]	Ozok H U, Sagnak L, Senturk A B, et al.A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilatation in percutaneous nephrolithotomy[J].J Endourol, 2012, 26 (6):630-634.
[4]	李文成, 梁华庚, 石瑛, 等.一种新的经皮肾镜通道建立方法刺激性利尿一步扩张法通道建立技术[J].临床泌尿外科杂志, 2015, 30 (6):514-517, 520.
[5]	Frattini A, Barbieri A, Salsi P, et al.One shot:a novel method to dilate the nephrostomy access for percutaneous lithotripsy[J].J Endourol, 2001, 15 (9):919-923.
[6]	Falahatkar S, Neiroomand H, Akbarpour M, et al.Oneshot versus metal telescopic dilatation technique for tract creation in percutaneous nephrolithotomy:comparison of safety and efficacy[J].J Endourol, 2009, 23 (4):615-618.
[7]	李文成, 杨雄, 潘峰, 等.一步扩张法标准通道和大通道建立技术在复杂性肾结石经皮肾镜取石术中的应用[J].临床泌尿外科杂志, 2014, 29 (10):898-902.
[8]	Kessaris D N, Bellman G C, Pardalidis N P, et al.Management of hemorrhage after percutaneous renal surgery[J].J Urol, 1995, 153 (3Pt 1):604-608.
[9]	Ozok H U, Sagnak L, Senturk A B, et al.A comparison of metal telescopic dilators and Amplatz dilators for nephrostomy tract dilatation in percutaneous nephrolithotomy[J].J Endourol, 2012, 26 (6):630-634.