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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (04) : 285 -288. doi: 10.3877/cma.j.issn.1674-3253.2021.04.004

临床研究

可视穿刺经皮肾镜治疗≤2 cm肾下盏结石的临床应用
谢杰1,†(), 王强东1, 董振佳1, 肖旭1, 杨银1   
  1. 1. 223300　江苏，淮安市淮阴医院泌尿外科
  • 收稿日期:2020-06-08 出版日期:2021-08-01
  • 通信作者: 谢杰
  • 基金资助:
    2019年度淮安市卫生健康科研项目(HAWJ201928)

"All seeing needle" for the treatment of lower renal calyx stone of less than 2 cm in diameter in percutaneous nephrolithotripsy

Jie Xie1,†(), Qiangdong Wang1, Zhenjia Dong1, Xu Xiao1, Yin Yang1   

  1. 1. Department of Urology, Huaiyin Hospital of Huai'an City, Jiangsu 223300, China
  • Received:2020-06-08 Published:2021-08-01
  • Corresponding author: Jie Xie
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谢杰, 王强东, 董振佳, 肖旭, 杨银. 可视穿刺经皮肾镜治疗≤2 cm肾下盏结石的临床应用[J]. 中华腔镜泌尿外科杂志(电子版), 2021, 15(04): 285-288.

Jie Xie, Qiangdong Wang, Zhenjia Dong, Xu Xiao, Yin Yang. "All seeing needle" for the treatment of lower renal calyx stone of less than 2 cm in diameter in percutaneous nephrolithotripsy[J]. Chinese Journal of Endourology(Electronic Edition), 2021, 15(04): 285-288.

目的

比较可视穿刺镜下直接钬激光碎石术与可视穿刺微通道经皮肾镜碎石取石术治疗最大径≤2 cm肾下盏结石的安全性和疗效。

方法

收集2019年3月至2019年12月间我院治疗的60例肾下盏结石患者的临床资料，结石最大径均<2 cm，其中可视穿刺后直接行钬激光碎石术（Microperc组）治疗30例，可视穿刺成功后扩张至微通道（16 F）行经皮肾镜碎石取石术（mPCNL组）治疗30例；两组患者术前一般临床资料差异均无统计学意义。比较两组患者手术相关指标、清石率和并发症等情况。

结果

Microperc组手术时间（51.3±8.5） min长于mPCNL组（37.8±6.1）min，而术后住院日（3.2±0.4）d则短于mPCNL组（5.4±0.6）d，疼痛视觉评分（3.12±0.93）低于mPCNL组（5.08±1.21），差异均有统计学意义（P<0.05）。两组术中最高肾盂压、血红蛋白下降、术后感染发热、出血、肾周血肿等并发症发生情况比较，差异均无统计学意义（P>0.05）；术后1个月、3个月复查CT评估排石情况，术后1个月Microperc组清石率（80%）低于mPCNL组（100%），差异有统计学意义；术后3个月两组清石率差异无统计学意义。

结论

可视穿刺经皮肾镜治疗≤2 cm肾下盏结石安全、有效，清石率高，并发症发生率低，可作为肾下盏结石的有效手术方案之一。

关键词: 肾下盏结石, 可视穿刺, 经皮肾镜
Objective

To compare the safety and efficacy of "all seeing needle" in percutaneous nephrolithotripsy (Microperc) and microchannel percutaneous nephrolithotripsy (mPCNL) for the treatment of lower renal calyx stone with maximum diameter less than 2 cm.

Methods

Clinical data of 60 patients with lower renal calyx stone treated in our hospital from March 2019 to December 2019 were analyzed. The maximum diameter of stones was ≤2 cm. Percutaneous nephrolithotomy was performed directly after puncture in 30 cases (Microperc group), and after successful puncture, they were expanded to microchannel (16 F) and percutaneous nephrolithotripsy in other 30 cases (mPCNL group). There was no statistical difference in clinical data before operation between the two groups. The operation-related indexes, clearing rate and complications of the two groups were compared.

Result

The operation time in the Microperc group (51.3±8.5) min was longer than that in the mPCNL group (37.8±6.1) min, the postoperative hospital stay (3.2±0.4) d was shorter than that in the mPCNL group (5.4±0.6) d, and the pain VAS score (3.12±0.93) was lower than mPCNL group (5.08±1.21), the differences were significant (P<0.05). There was no significant difference in the incidence of complications such as maximum renal pelvis pressure, decreased hemoglobin, postoperative infection fever, hemorrhage, and perirenal hematoma between the two groups (P>0.05). CT was reviewed in 1 month and 3 months after surgery, the stone removal rate (80%) in the Microperc group was lower than that in the mPCNL group (100%) at 1 month after surgery, and the difference was significant. There was no difference in the stone removal rate between the two groups at 3 months after surgery.

Conclusion

"All seeing needle" in percutaneous nephrolithotripsy is safe and effective for treatment of <2 cm inferior calyx stones, with high clearing rate and low complication rate. It can be used as one of the effective surgical options for lower renal calyx stone.

Key words: Lower renal calyx stone, All seeing needle, Percutaneous nephrolithotripsy
表1 两组结石患者术前一般临床资料比较
组别 例数 性别(例) 年龄[岁，(±s)] 结石最大径[cm，(±s)] 合并尿路感染(例)
男 女
Microperc组 30 20 10 39.3±9.7 1.48±0.21 3
mPCNL组 30 17 13 41.2±10.3 1.57±0.19 5
统计值   χ2=0.6345 t=1.3845 t=1.7407 χ2=0.1442
P值   >0.05 >0.05 >0.05 >0.05
表2 两组结石患者手术相关参数比较
组别 例数 手术时间[min，(±s)] 术中最高肾盂压[cmH2O，(±s)] 术后住院天数[d，(±s)] 疼痛视觉评分[分，(±s)] 血红蛋白下降量[g/L，(±s)] 并发症(例) 术后1个月清石率(%) 术后3个月清石率(%)
Microperc组 30 51±8 22±6 3.2±0.4 3.1±0.9 6.6±2.1 3 80.0 93.3
mPCNL组 30 38±6 24±6 5.4±0.6 5.1±1.2 8.0±3.5 4 100 100
统计值   t =7.067 t =1.822 t =16.710 t =7.034 t =1.945 0.000 χ2=4.629 χ2=0.517
P值   <0.05 >0.05 <0.05 <0.05 >0.05 >0.05 <0.05 0.05
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