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中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 103 -107. doi: 10.3877/cma.j.issn.1674-3253.2021.02.004

所属专题: 文献

临床研究

新型止血内鞘在无管化经皮肾镜中的临床应用
王学雷1, 黄立群1, 王金善2, 张文元2, 赵俊2, 沈林洁1, 袁宇峰1, 杨国胜1, 温晓飞3,()   
  1. 1. 200120 上海,上海市东方医院泌尿外科
    2. 343000 江西吉安,上海市东方医院吉安医院泌尿外科
    3. 200120 上海,上海市东方医院泌尿外科;343000 江西吉安,上海市东方医院吉安医院泌尿外科
  • 收稿日期:2020-11-27 出版日期:2021-04-01
  • 通信作者: 温晓飞
  • 基金资助:
    江西省卫生健康委科技计划项目(20184075)

The clinical application of a kind of innovative hemostatic sheath in tubeless percutaneous nephrolithotomy

Xuelei Wang1, Liqun Huang1, Jinshan Wang2, Wenyuan Zhang2, Jun Zhao2, Linjie Shen1, Yufeng Yuan1, Guosheng Yang1, Xiaofei Wen3,()   

  1. 1. Department of Urology, Shanghai East Hospital, Shanghai 200120, China
    2. Department of Urolgy, Ji'an Hospital of Shanghai East Hospital, Jiangxi 343000, China
    3. Department of Urology, Shanghai East Hospital, Shanghai 200120, China; Department of Urolgy, Ji'an Hospital of Shanghai East Hospital, Jiangxi 343000, China
  • Received:2020-11-27 Published:2021-04-01
  • Corresponding author: Xiaofei Wen
引用本文:

王学雷, 黄立群, 王金善, 张文元, 赵俊, 沈林洁, 袁宇峰, 杨国胜, 温晓飞. 新型止血内鞘在无管化经皮肾镜中的临床应用[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(02): 103-107.

Xuelei Wang, Liqun Huang, Jinshan Wang, Wenyuan Zhang, Jun Zhao, Linjie Shen, Yufeng Yuan, Guosheng Yang, Xiaofei Wen. The clinical application of a kind of innovative hemostatic sheath in tubeless percutaneous nephrolithotomy[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(02): 103-107.

目的

通过使用新型止血内鞘对皮肾通道内的出血点进行电凝止血,提高无管化经皮肾镜的安全性。

方法

回顾性分析了2015年7月至2020年6月无管化经皮肾镜手术患者586例的临床资料。在经皮肾镜碎石结束后常规检查通道,使用自行设计的新型止血内鞘对通道内的明显止血点进行电凝止血。分析通道止血病例的手术时间、止血时间、术后血红蛋白的下降、输血率、肾动脉栓塞比例等临床资料。

结果

586例无管化经皮肾镜中,103例在通道检查时发现有明显出血点,予止血鞘止血后不留置肾造瘘管。通道止血的病例其经皮肾镜碎石手术时间53~105 min,通道止血时间7~19 min。术后次日血红蛋白下降7~21 g/L,平均14 g/L,术后2 d血红蛋白下降11~32 g/L,平均19 g/L。术后无输血或肾动脉栓塞发生。术后2周结石清石率94.5%(554/586)。2例少量肾脏包膜下血肿,6例少量患侧胸腔积液,均经保守治疗痊愈。

结论

常规皮肾通道检查,使用新型止血内鞘进行电凝止血,可以减少无管化经皮肾镜的术后出血,减少输血及肾动脉栓塞的发生,提高无管化经皮肾镜的安全性。

Objective

To improve the safety of tubeless percutaneous nephrolithotomy by using a kind of innovative hemostatic sheath to electrocoagulate the bleeding in the percutaneous renal channel.

Method

The clinical data of 586 patients with tubeless percutaneous nephrolithotomy from July 2015 to June 2020 were retrospectively analyzed. After finishing the process of percutaneous nephrolithotomy, the self-designed innovative hemostatic sheath was used to electrocoagulate the bleeding found in the percutaneous renal channel by routine check. The operation time, hemostasis time, decrease of hemoglobin after operation, blood transfusion rate and renal artery embolism ratio were analyzed.

Result

In 586 cases of tubeless percutaneous nephrolithotomy, 103 cases were found to have obvious bleeding in the percutaneous renal channel. The self-designed innovative hemostatic sheath was used to electrocoagulate the bleeding and no nephrostomy tube was left. The operation time of percutaneous nephrolithotomy was 53-105 minutes and the hemostasis time was 7-19 minutes. After operation, hemoglobin decreased 7-21g/L(average 14 g/L) on the next day and decreased 11-32 g/L(average 19 g/L) 2 days later. No blood transfusion or renal artery embolism occurred. The stone removal rate was 94.5%(554/586) 2 weeks after operation. There were 2 cases of renal subcapsular hematoma and 6 cases of pleural effusion, all cured by conservative treatment.

Conclusion

Routine channel examination and electrocoagulation by innovative hemostatic sheath can reduce postoperative bleeding, blood transfusion and renal artery embolism, and improve the safety of tubeless percutaneous nephrolithotomy.

图5 止血鞘止血外景
图8 止血成功
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