【摘要】 目的:探讨不同监视方式球囊扩张通道在无积水肾盏经皮肾镜取石术(PCNL)中的有效性及安全性。方法:回顾性分析2019年3月-2021年3月60例行单通道无积水肾盏球囊扩张PCNL患者临床资料。按照通道建立方式的不同分为超声组及联合组。超声组为全B超定位穿刺及监视通道球囊扩张;联合组为B超定位穿刺,X线监视通道球囊扩张。比较两组通道建立方式的有效性(通道建立时间、一次通道扩张成功率、手术时间、术后清石率)及安全性(术后Hb变化、术后并发症、无造瘘管比率及术后住院天数)等指标。结果:60例患者均成功完成手术,平均通道建立时间(5.23±1.57)min,一次通道扩张成功率81.67%(49/60),手术时间65.00(43.75)min,清石率96.67%(58/60);术后Hb下降约(1.85±8.72)g/L,术后并发症发生率5.00%(3/60),其中2例为Clavien-DindoⅠ级,1例为Ⅲa级,术后无管化率为23.33%(14/60),术后住院天数为4.00(1.00)d。在不同通道监视方式的比较中,超声组及联合组在患者年龄、结石大小、形态及BMI等均无显著性差异,而联合组有更高的一次通道扩张成功率(93.10%vs.70.97%, P<0.05)及术后的无管化(34.48%vs. 12.90%, P<0.05)。结论:球囊扩张通道在无积水肾盏PCNL中的应用安全有效。相比较全B超监视,B超联合X线进行无积水肾盏球囊通道建立有助于术中更高的一次通道成功率及术后的无管化。更多还原

【Abstract】 Objective:To determine the efficacy and safety of balloon dilation percutaneous nephrolithotomy(PCNL) for undilated targeted calyxes monitored by different methods. Methods:We retrospectively included 60 consecutive patients with kidney stones and the patients were treated by one single balloon dilation tract for undilated targeted calyxes from March 2019 to March 2021. Patients were divided into two groups(ultrasound group and combined group) according to the technique of tract dilation. Tract puncture and dilation were totally monitored by ultrasound in the ultrasound group and by ultrasound and X-ray in the combined group. Efficacy(tract establishment time, firsttime dilation success rate, surgical duration, stone-free rate) and safety(Hb drop, postoperative complication rate, postoperative tubeless rate, postoperative hospital stay) were compared between the two groups. Results:All 60 patients were operated successfully with mean tract establishment time of(5.23±1.57) min, surgical duration of 65.00(43.75) min, stone-free rate of 96.67%(58/60), mean Hb drop of(1.85±8.72) g/L, postoperative tubeless rate of 23.33%(14/60), and postoperative hospital stay of 4.00(1.00) d. Tract dilation succeeded in 81.67%(49 succeeded and 11 failed) patients at first attempt. The total rate of complications was 5.00%(3/60) including two cases of Clavien-Dindo Ⅰ and one case of Clavien-Dindo Ⅲ a. No significant differences in age, stone diameter, stone form and body mass index were found between the ultrasound and combined groups. However, the combined group had higher first-time dilation success rate(93.10% vs. 70.97%, P < 0.05) and postoperative tubeless rate(34.48% vs. 12.90%, P < 0.05) than in the ultrasound group. Conclusion:Balloon dilation PCNL is efficient and safe for undilated targeted calyxes. However, tract creation monitored by ultrasound combined with X-ray has higher first-time dilation success rate and postoperative tubeless rate than totally ultrasound-guided tract creation.更多还原