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中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (02) : 108 -112. doi: 10.3877/cma.j.issn.1674-3253.2021.02.005

所属专题: 文献

临床研究

肾盂低压并高效清石的增强版超微经皮肾镜技术
闻俊军1, 彭林杰1, 钟文1,()   
  1. 1. 510230 广州医科大学附属第一医院泌尿外科,广东省泌尿外科重点实验室,广州泌尿外科研究所
  • 收稿日期:2020-05-15 出版日期:2021-04-01
  • 通信作者: 钟文
  • 基金资助:
    广州市科技计划项目珠江科技新星专项(201610010169); 广州市教育局市属高校科研项目(1201620038)

Enhanced SMP (eSMP) technique: low renal pelvic pressure and high lithotripsy efficiency

Junjun Wen1, Linjie Peng1, Wen Zhong1,()   

  1. 1. Department of Urology, the First Affiliated Hospital of Guangzhou Medical University; Guangdong Provincial Key Laboratory of Urology; Guangzhou Institute of Urology, Guangzhou 510230 , China
  • Received:2020-05-15 Published:2021-04-01
  • Corresponding author: Wen Zhong
引用本文:

闻俊军, 彭林杰, 钟文. 肾盂低压并高效清石的增强版超微经皮肾镜技术[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(02): 108-112.

Junjun Wen, Linjie Peng, Wen Zhong. Enhanced SMP (eSMP) technique: low renal pelvic pressure and high lithotripsy efficiency[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(02): 108-112.

目的

近年来超微经皮肾镜碎石取石术(SMP)技术飞速发展,逐步成熟,但14 F超微通道处理大负荷肾结石可能导致手术时间延长。我们在SMP基础上将灌注负压吸引鞘增大为18 F,以期提高碎石效率并保持肾盂内低压。本研究通过对比分析18 F增强版超微经皮肾镜碎石取石术(eSMP)与同为18 F通道的微创经皮肾镜碎石取石术(mPCNL)治疗2~5 cm肾结石的术中肾盂内压及取石效率等指标,验证eSMP技术的安全有效性。

方法

2017年1月至2019年12月,我院100例肾结石患者接受PCNL治疗,随机分入eSMP组和mPCNL组。建立18 F通道,eSMP组采用灌注吸引鞘,mPCNL组采用剥离鞘,分别用超微肾镜(11 F)和8/9.8 F输尿管镜,钬激光联合气压弹道碎石器碎石取石。术中监测肾盂内压,并记录手术时间、碎石时间、结石体积以及并发症等数据,进行统计学分析。

结果

mPCNL组与eSMP组取出结石体积差异无统计学意义,但mPCNL组碎石取石所耗时间显著长于eSMP组[(50.1±19.6)min vs (35.3±14.3)min,t=4.314,P<0.001],因而单位时间内eSMP取石更多[(13.66±1.17)mm3/h vs (9.78±1.23)mm3/h,t=16.150,P<0.001],且总的手术时间上mPCNL组相较eSMP组也显著延长[(67.3±19.5)min vs(52.1±14.4)min,t=4.429,P<0.001]。术中肾盂内压mPCNL组显著高于eSMP组[(17.88±3.28)mmHg vs(12.01±2.45)mmHg,t=10.140,P<0.001],mPCNL组术中肾盂内压>30 mmHg累计时间显著长于eSMP组[(23.2±16.6) s vs (3.8±4.3) s,t=8.012,P<0.001]。术后血红蛋白下降量mPCNL组较eSMP组更显著[(17.1±6.8)g/L vs(14.0±7.5)g/L,t=2.182,P=0.032]。两组患者术后发热率、结石清除率的差异均无统计学意义,但mPCNL组住院时间显著长于eSMP组[(2.98±0.87)d vs (2.60±0.78)d,t=2.298,P<0.001]。

结论

增强版SMP(eSMP)借助于灌注负压吸引鞘,相较传统mPCNL,能够提高碎石取石效率,并保持术中较低的肾盂内压,治疗2~5 cm肾结石是安全有效的。

Objective

In recent years, the super mini-PCNL (SMP) technique has developed rapidly and matured gradually. However, the operation time may be prolonged when manage the large burden renal calculi with 14 F tract. On the basis of SMP, the suction sheath was increased to 18 F, in the aim to improve the lithotripsy efficiency and keep a low renal pelvic pressure, which was called enhanced-SMP (eSMP). In the present study, eSMP and mini-PCNL was compared to analyze the intra-operative renal pelvic pressure and stone removal efficiency when managed the 2-5 cm renal calculi, and to verify the safety and efficiency of eSMP technique.

Methods

From January 2017 to December 2019, 100 patients with 2-5 cm renal calculi in our hospital were randomly divided into eSMP group and mPCNL group. 18 Fpercutaneous tract was established, suction sheath with 11 F mini nephroscope and peel-away sheath with 8/9.8 F ureteroscope was used in eSMP and mPCNL, respectively. Ho:YAG laser and pneumatic lithotriptor was used for lithotripsy. During the operation, renal pelvic pressure was measured, operation time, lithotripsy time, removed stone volume and complications were recorded and analyzed statistically.

Results

There was no significant difference in the stone volume removed between mPCNL group and eSMP group, but the lithotripsy time in mPCNL was significantly longer than eSMP group [(50.1±19.6) min vs (35.3±14.3)min, t=4.314, P<0.001], thus the stone removal effectiveness was higher in eSMP group [(13.66±1.17) mm3/h vs (9.78±1.23) mm3/h, t=16.150, P<0.001], and the total operation time in mPCNL group was longer than eSMP group [(67.3±19.5) min vs (52.1±14.4) min, t=4.429, P<0.001]. The intra-operative renal pelvic pressure in mPCNL group was higher than eSMP group [(17.88±3.28) mmHg vs (12.01±2.45) mmHg, t=10.140, P<0.001], and also the accumulated time of renal pelvic pressure >30 mmHg in mPCNL group was longer than eSMP group [(23.2±16.6) s vs (3.8±4.3) s, t=8.012, P<0.001]. The postoperative decreased hemoglobin in mPCNL group was more than eSMP group [(17.1±6.8) g/L vs (14.0±7.5) g/L, t=2.182, P=0.032]. There was no significant difference in the postoperative fever rate and stone clearance rate, while the hospital stay in mPCNL group was longer than eSMP group [(2.98±0.87) d vs (2.60±0.78) d, t=2.298, P<0.001].

Conclusion

Enhanced SMP (eSMP) was safe and effective in the management of 2-5 cm renal calculi. On the basis of irrigation-suction sheath, eSMP can keep a lower renal pelvic pressure and higher lithotripsy efficiency when compared to traditional mPCNL.

表1 mPCNL对比eSMP治疗2~5 cm肾结石患者一般资料
表2 mPCNL对比eSMP治疗2~5 cm肾结石结果
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