中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2014年
12期
881-884
,共4页
球囊扩张法%肾造口术,经皮%肾结石%鹿角形结石
毬囊擴張法%腎造口術,經皮%腎結石%鹿角形結石
구낭확장법%신조구술,경피%신결석%록각형결석
Balloon dilation%Nephrostomy,percutaneous%Kidney calculi%Staghorn stones
目的 探讨24 F球囊扩张法经皮肾镜取石术处理鹿角形结石的安全性及有效性.方法 回顾性分析2013年4月至2014年4月收治的64例鹿角形肾结石患者的临床资料,按通道扩张方式分为球囊组(采用球囊扩张器扩张至24 F,31例)和筋膜扩张器组(采用筋膜扩张器扩张至16 F,33例).两组患者的性别、年龄、体质指数以及结石位置和大小比较差异均无统计学意义(P＞0.05).分别记录两组的建立通道时间、一次通道建立成功率、穿刺并发症(肾盏破裂、肾周积液及术后延迟性出血等)、清除结石时间、结石清除率、术后血红蛋白下降值、术后发热＞37.5℃例数等.测量并记录两组术中肾盂内压变化. 结果 球囊组及筋膜扩张器组建立通道时间[(5.6±2.1)、(9.4±1.7) min]、一次通道建立成功率[100％(31/31)、88％ (29/33)]、清除结石时间[(32.4±3.4)、(49.5±3.7) min]、一期结石清除率[84％(26/31)、61％(20/33)]、术后血红蛋白下降值[(16.7±3.3)、(28.4±2.6) g/L]、术中肾盂内压[(19±3)、(25±6) mmHg,1 mmHg=0.133 kPa]及术后发热率[16％(5/31)和39％(13/33)]比较差异均有统计学意义(P＜0.05).64例均未损伤胸膜、脾脏及十二指肠等邻近脏器. 结论 应用球囊扩张法建立24 F经皮肾通道快速、安全、出血少,术中肾盂内压低,应用于鹿角形结石经皮肾镜取石术时结石清除率高、并发症少.
目的 探討24 F毬囊擴張法經皮腎鏡取石術處理鹿角形結石的安全性及有效性.方法 迴顧性分析2013年4月至2014年4月收治的64例鹿角形腎結石患者的臨床資料,按通道擴張方式分為毬囊組(採用毬囊擴張器擴張至24 F,31例)和觔膜擴張器組(採用觔膜擴張器擴張至16 F,33例).兩組患者的性彆、年齡、體質指數以及結石位置和大小比較差異均無統計學意義(P＞0.05).分彆記錄兩組的建立通道時間、一次通道建立成功率、穿刺併髮癥(腎盞破裂、腎週積液及術後延遲性齣血等)、清除結石時間、結石清除率、術後血紅蛋白下降值、術後髮熱＞37.5℃例數等.測量併記錄兩組術中腎盂內壓變化. 結果 毬囊組及觔膜擴張器組建立通道時間[(5.6±2.1)、(9.4±1.7) min]、一次通道建立成功率[100％(31/31)、88％ (29/33)]、清除結石時間[(32.4±3.4)、(49.5±3.7) min]、一期結石清除率[84％(26/31)、61％(20/33)]、術後血紅蛋白下降值[(16.7±3.3)、(28.4±2.6) g/L]、術中腎盂內壓[(19±3)、(25±6) mmHg,1 mmHg=0.133 kPa]及術後髮熱率[16％(5/31)和39％(13/33)]比較差異均有統計學意義(P＜0.05).64例均未損傷胸膜、脾髒及十二指腸等鄰近髒器. 結論 應用毬囊擴張法建立24 F經皮腎通道快速、安全、齣血少,術中腎盂內壓低,應用于鹿角形結石經皮腎鏡取石術時結石清除率高、併髮癥少.
목적 탐토24 F구낭확장법경피신경취석술처리록각형결석적안전성급유효성.방법 회고성분석2013년4월지2014년4월수치적64례록각형신결석환자적림상자료,안통도확장방식분위구낭조(채용구낭확장기확장지24 F,31례)화근막확장기조(채용근막확장기확장지16 F,33례).량조환자적성별、년령、체질지수이급결석위치화대소비교차이균무통계학의의(P＞0.05).분별기록량조적건립통도시간、일차통도건립성공솔、천자병발증(신잔파렬、신주적액급술후연지성출혈등)、청제결석시간、결석청제솔、술후혈홍단백하강치、술후발열＞37.5℃례수등.측량병기록량조술중신우내압변화. 결과 구낭조급근막확장기조건립통도시간[(5.6±2.1)、(9.4±1.7) min]、일차통도건립성공솔[100％(31/31)、88％ (29/33)]、청제결석시간[(32.4±3.4)、(49.5±3.7) min]、일기결석청제솔[84％(26/31)、61％(20/33)]、술후혈홍단백하강치[(16.7±3.3)、(28.4±2.6) g/L]、술중신우내압[(19±3)、(25±6) mmHg,1 mmHg=0.133 kPa]급술후발열솔[16％(5/31)화39％(13/33)]비교차이균유통계학의의(P＜0.05).64례균미손상흉막、비장급십이지장등린근장기. 결론 응용구낭확장법건립24 F경피신통도쾌속、안전、출혈소,술중신우내압저,응용우록각형결석경피신경취석술시결석청제솔고、병발증소.
Objective To access the safety and efficacy of balloon dilation in percutaneous nephrolithotomy for staghorn stones.Methods Clinical data of 64 patients with staghorn stone according to the inclusion criteria in our institution from April 2013 to April 2014 were collected and analyzed retrospectively.According to the dilation methods,the patients were divided into balloon dilation group (dilated to 24 F by balloon dilator,31 cases) and fascial dilation group (dilated to 16 F by Amplatz fascial dilator,33 cases).There was no significant difference in sex,age,body mass index between the 2 groups.The data of duration of percutaneous access,one-attempt success rate of dilation,puncture complications (kidney calices fracture,perinephric fluid collection and postoperative delayed hemorrhage etc.),removing stones time,stone free rate,hemoglobin drop after surgery and number of patients who experienced postoperative fever ＞37.5 ℃ were recorded.Results Compare to fascial dilation group,balloon dilatation group had significant differences in terms of duration of percutaneous access [(5.6± 2.1) min versus (9.4± 1.7) min],oneattempt success rate of dilation[100％ (31/31) versus 88％ (29/33)],removing stone time[(32.4±3.4) min versus (49.5±3.7) min],stone free rate [84％ (26/31) versus 61％ (20/33)],hemoglobin drop after surgery [(16.7±3.3) g/L versus (28.4±2.6) g/L],renal intrapelvic pressure[(19±3) mmHg versus (25±6) mmHg] and rate of patients who experienced postoperative fever ＞37.5 ℃ [16％ (5/31) versus 39％(13/33)] (P＜0.05).No injury of adjacent organs,including pleura,liver,spleen,or bowel was noted in all patients.Conclusions Balloon dilation is quick and safe with less hemorrhage when building percutaneous renal channel.And it has higher stone free rate and less complication rate in percutaneous nephrolithotomy with staghorn stones.
