The application of negative pressure suction sheath in minimally invasive percutaneous nephrolithotomy

doi:10.3877/cma.j.issn.1674-3253.2023.02.008

Abstract

Abstract:

Objective

To compare the safety and efficacy of negative pressure suction sheath and peel-away sheath in minimally invasive percutaneous nephrolithotomy (MPCNL) for 2-5 cm renal calculi.

Methods

From 2019, 50 patients with 2-5 cm renal calculi were enrolled into two groups. 18 F percutaneous tract was established, suction sheath and peel-away sheath were used in different groups. Preoperative data, operation time, lithotripsy time, stone removal volume and perioperative complications were recorded and analyzed statistically.

Results

There was no significant difference in preoperative data between the two groups. There was no significant difference in stone removal volume [(8±3) vs (8±4) mm³, P=0.781] during MPCNL, but the time consumed [(37±16) vs (50±20) min, P=0.016] for lithotripsy in the negative pressure suction sheath group was significantly shorter than peel-away sheath group, therefore, the lithotripsy efficiency [(13.5±1.0) vs (9.7±1.14) mm³/h, P<0.001] of the negative pressure suction sheath group was significantly higher than peel-away sheath group. The total operation time [(54±16) vs (67±20) min, P=0.014] in the negative pressure suction sheath group was significantly shorter than that of ordinary sheath group. The decrease of hemoglobin [(14±6) vs (19±8) g/L, P=0.013] in the negative pressure suction sheath group was less than peel-away sheath group. The postoperative fever rate (4% vs 24%, P=0.042) was lower in the negative pressure suction sheath group.

Conclusions

Negative pressure suction sheath in MPCNL can improve the lithotripsy efficiency, shorten the operation time, effectively reduce the blood loss and postoperative fever, which is a safe and effective technique.

Key words: Negative pressure suetion sheath, Renal calculi, PCNL, Complication

Hangong Fan, Cong Liu, Jiahui Hong, Yueyue Lin, Siqi Lin. The application of negative pressure suction sheath in minimally invasive percutaneous nephrolithotomy[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(02): 140-143.

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Figures/Tables 2

References 16

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组别	例数	性别(例)		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	糖尿病[例(%)]	高血压[例(%)]	尿路感染[例(%)]	结石大小[cm，(±s)]	结石CT值[Hu，(±s)]	血肌酐[μmol/L，(±s)]	血红蛋白[g/L，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	糖尿病[例(%)]	高血压[例(%)]	尿路感染[例(%)]	结石大小[cm，(±s)]	结石CT值[Hu，(±s)]	血肌酐[μmol/L，(±s)]	血红蛋白[g/L，(±s)]
普通鞘组	25	18	7	49±9	23.4±2.0	1(4)	5(20)	7(28)	3.3±0.9	1127±203	105±51	138±10
负压吸引鞘组	25	17	8	49±8	24.1±1.9	2(8)	4(16)	6(24)	3.3±1.0	1100±234	123±77	137±11
统计值		χ²=0.095		t=0.101	t=1.178	χ²=0.355	χ²=0.136	t=0.104	t=0.122	t=0.430	t=0.985	t=0.245
P值		0.758		0.920	0.245	0.552	0.713	0.747	0.904	0.669	0.329	0.807

组别	例数	性别(例)		年龄[岁，(±s)]	BMI[kg/m²，(±s)]	糖尿病[例(%)]	高血压[例(%)]	尿路感染[例(%)]	结石大小[cm，(±s)]	结石CT值[Hu，(±s)]	血肌酐[μmol/L，(±s)]	血红蛋白[g/L，(±s)]
组别	例数	男	女	年龄[岁，(±s)]	BMI[kg/m²，(±s)]	糖尿病[例(%)]	高血压[例(%)]	尿路感染[例(%)]	结石大小[cm，(±s)]	结石CT值[Hu，(±s)]	血肌酐[μmol/L，(±s)]	血红蛋白[g/L，(±s)]
普通鞘组	25	18	7	49±9	23.4±2.0	1(4)	5(20)	7(28)	3.3±0.9	1127±203	105±51	138±10
负压吸引鞘组	25	17	8	49±8	24.1±1.9	2(8)	4(16)	6(24)	3.3±1.0	1100±234	123±77	137±11
统计值		χ²=0.095		t=0.101	t=1.178	χ²=0.355	χ²=0.136	t=0.104	t=0.122	t=0.430	t=0.985	t=0.245
P值		0.758		0.920	0.245	0.552	0.713	0.747	0.904	0.669	0.329	0.807

组别	例数	碎石时间[min，(±s)]	结石体积(mm³)	取石速度(mm³/h)	使用钬激光(%)	手术时间[min，(±s)]	术后血肌酐[μmol/L，(±s)]	术后血红蛋白[g/L，(±s)]
普通鞘组	25	50±20	8±3	9.7±1.1	16	67±20	117±52	118±12
负压吸引鞘组	25	37±16	8±4	13.5±1.0	12	54±16	124±64	123±11
统计值		t=2.499	t=0.279	t=12.459	χ²=0.166	t=2.538	t=0.446	t=1.296
P值		0.016	0.781	<0.001	0.684	0.014	0.658	0.201
组别	血红蛋白下降量[g/L，(±s)]	结石清除率[例(%)]	术后住院时间[d，(±s)]	并发症[例(%)]		结石成分[例(%)]
组别	血红蛋白下降量[g/L，(±s)]	结石清除率[例(%)]	术后住院时间[d，(±s)]	发热	疼痛	草酸钙	磷酸镁铵	碳酸磷灰石	尿酸	胱氨酸
普通鞘组	19±8	21(84)	5.1±1.0	6(24)	2(8)	17(68)	1(4)	4(20)	2(8)	1(4)
负压吸引鞘组	14±6	22(88)	4.7±0.7	1(4)	2(8)	19(76)	2(8)	3(12)	1(4)	0
统计值	t=2.570	χ²=0.166	t=1.846	χ²=4.153	χ²=0.000	χ²=0.811
P值	0.013	0.684	0.071	0.042	1.000	0.418

组别	例数	碎石时间[min，(±s)]	结石体积(mm³)	取石速度(mm³/h)	使用钬激光(%)	手术时间[min，(±s)]	术后血肌酐[μmol/L，(±s)]	术后血红蛋白[g/L，(±s)]
普通鞘组	25	50±20	8±3	9.7±1.1	16	67±20	117±52	118±12
负压吸引鞘组	25	37±16	8±4	13.5±1.0	12	54±16	124±64	123±11
统计值		t=2.499	t=0.279	t=12.459	χ²=0.166	t=2.538	t=0.446	t=1.296
P值		0.016	0.781	<0.001	0.684	0.014	0.658	0.201
组别	血红蛋白下降量[g/L，(±s)]	结石清除率[例(%)]	术后住院时间[d，(±s)]	并发症[例(%)]		结石成分[例(%)]
组别	血红蛋白下降量[g/L，(±s)]	结石清除率[例(%)]	术后住院时间[d，(±s)]	发热	疼痛	草酸钙	磷酸镁铵	碳酸磷灰石	尿酸	胱氨酸
普通鞘组	19±8	21(84)	5.1±1.0	6(24)	2(8)	17(68)	1(4)	4(20)	2(8)	1(4)
负压吸引鞘组	14±6	22(88)	4.7±0.7	1(4)	2(8)	19(76)	2(8)	3(12)	1(4)	0
统计值	t=2.570	χ²=0.166	t=1.846	χ²=4.153	χ²=0.000	χ²=0.811
P值	0.013	0.684	0.071	0.042	1.000	0.418

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