可视球囊扩张导管在经皮肾镜取石术中的应用(附20例报告)
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摘要
目的评价可视球囊扩张在经皮肾镜取石术(PCNL)中的可行性和安全性。方法回顾性分析2017年3月-2018年3月应用可视球囊扩张导管建立通道行PCNL的20例肾结石患者的病例资料。结果 20例均成功应用可视球囊建立皮肾通道,通道建立时间为5.0～13.5 min,平均(7.2±2.1)min,手术时间为30.0～120.0 min,平均(59.1±21.9)min。术后血尿(ClavienⅠ)2例,经保守治疗好转。发热(ClavienⅡ)1例,经抗生素治疗好转。1例残留结石行体外冲击波治疗。术后1个月无石率和手术成功率分别为90.00%和95.00%,术后3个月无石率为100.00%。结论可视球囊有助于提高建立皮肾通道的准确性和提高手术成功率。
Objective To evaluate the feasibility and safety of self-made optical balloon dilator for percutaneous nephrolithotomy(PCNL) in treatment of renal calculi. Methods There were 20 patients underwent PCNL with selfmade device for the tract establishment from March 2017 to March 2018, 12 cases of male and 8 cases of female.The mean±SD(range) patients' age was 26 ～ 73(47.8 ± 12.7) years, stone volume was 2.0 ～ 3.5(2.5 ± 0.4) cm and stone density was 579 ～ 1247(978.7 ± 221.6) HU. The factors analysed were demographic variables including age,sex, stone volume, stone density(HU) and stone location, and intra-and peri-operative variables such as operating time, drop in haemoglobin level, stone clearance and complications. Results All tracts were successfully developed with the optical nephrostomy balloon dilator. Tract development time was 5.0 ～ 13.5(7.2 ± 2.1) min, and operation time was 30 ～ 120(59.1 ± 21.9) min. Two patients who suffered hematuria(Clavien Ⅰ) underwent conservative treatment and recovered well. Hemoglobin decrease was 3.4 ～ 10.4(5.5 ± 1.8) g/L, and hospital time was 4 ～ 7(5.1 ± 0.9) d. No patient required blood transfusion. There were no major complications, the respective stone free and success rate at the first month after operation was 90.00%(18/20) and 95.00%(19/20), and at the third month after operation was both 100.00%. One patient underwent ESWL and the fragments was discharged at 3 months follow up. Conclusion Optical balloon facilitate accurately developing tract and improving surgery success rate.
Objective To evaluate the feasibility and safety of self-made optical balloon dilator for percutaneous nephrolithotomy(PCNL) in treatment of renal calculi. Methods There were 20 patients underwent PCNL with selfmade device for the tract establishment from March 2017 to March 2018, 12 cases of male and 8 cases of female.The mean±SD(range) patients' age was 26 ～ 73(47.8 ± 12.7) years, stone volume was 2.0 ～ 3.5(2.5 ± 0.4) cm and stone density was 579 ～ 1247(978.7 ± 221.6) HU. The factors analysed were demographic variables including age,sex, stone volume, stone density(HU) and stone location, and intra-and peri-operative variables such as operating time, drop in haemoglobin level, stone clearance and complications. Results All tracts were successfully developed with the optical nephrostomy balloon dilator. Tract development time was 5.0 ～ 13.5(7.2 ± 2.1) min, and operation time was 30 ～ 120(59.1 ± 21.9) min. Two patients who suffered hematuria(Clavien Ⅰ) underwent conservative treatment and recovered well. Hemoglobin decrease was 3.4 ～ 10.4(5.5 ± 1.8) g/L, and hospital time was 4 ～ 7(5.1 ± 0.9) d. No patient required blood transfusion. There were no major complications, the respective stone free and success rate at the first month after operation was 90.00%(18/20) and 95.00%(19/20), and at the third month after operation was both 100.00%. One patient underwent ESWL and the fragments was discharged at 3 months follow up. Conclusion Optical balloon facilitate accurately developing tract and improving surgery success rate.
引文
[1]YU W,RAO T,LI X,et al.The learning curve for access creation in solo ultrasonography-guided percutaneous nephrolithotomy and the associated skills[J].Int Urol Nephrol,2017,49(3):419-424.
[2]ARSLAN B,AKBULUT M F,ONUK O,et al.A comparison of Amplatz dilators and metal dilators for tract dilatation in minipercutaneous nephrolithotomy[J].Int Urol Nephrol,2017,49(4):581-585.
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[7]张际青,张军晖,康宁,等.自制F4.85可视穿刺针联合输尿管通道鞘在超微经皮肾镜碎石术中的应用[J].中华泌尿外科杂志,2017,38(11):852-856.[7]ZHANG J Q,ZHANG J H,KANG N,et al.Effect of microperc for treatment of renal calculi with self-made optical puncture needle combined with ureteral access sheath[J].Chin J Urol,2017,38(11):852-856.Chinese
[8]NOURALIZADEH A,SHARIFIAGHDAS F,PAKMANESH H,et al.Fluoroscopy-free ultrasonography-guided percutaneous nephrolithotomy in pediatric patients:a single-center experience[J].World J Urol,2018,36(4):667-671.
[9]ZHANG J Q,WANG Y,ZHANG J H,et al.Retrospective analysis of ultrasound-guided flexible ureteroscopy in the management of calyceal diverticular calculi[J].Chinese Medical Journal,2016,129(17):2067-2073.
[10]SRIVASTAVA A,SINGH S,DHAYAL I R,et al.A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy[J].World J Urol,2017,35(5):803-807.
[11]JOEL A B,RUBENSTEIN J N,HSIEH M H,et al.Failed percutaneous balloon dilation for renal access:incidence and risk factors[J].Urology,2005,66(1):29-32.
[12]DEHONG C,LIANGREN L,HUAWEI L,et al.A comparison among four tract dilation methods of percutaneous nephrolithotomy:a systematic review and meta-analysis[J].Urolithiasis,2013,41(6):523-530.
[13]NALBANT I,KARAKOYUNLU A N,YESIL S,et al.Comparison of dilation methods in percutaneous nephrolithotomy:which one is more successful[J].J Laparoendosc Adv Surg Tech A,2016,26(6):478-482.
[14]TSAI Y S,JOU Y C,SHEN C H,et al.Antegrade ureteroscopic assistance during percutaneous nephrolithotomy for complete renal staghorn stone:technique and outcomes[J].Urological Science,2015,26(1):61-64.
[15]TURNA B,NAZLI O,DEMIRYOGURAN S,et al.Percutaneous nephrolithotomy:variables that influence hemorrhage[J].Urology,2007,69(4):603-607.
[16]FERRANDINO M N,BAGRODIA A,PIERRE S A,et al.Radiation exposure in the acute and short-term management of urolithiasis at 2 academic centers[J].J Urol,2009,181(2):668-672.
[17]DUDLEY A G,DWYER M E,FOX J A,et al.Prospective assessment of radiation in pediatric urology:the pediatric urology radiation safety evaluation study[J].J Urol,2016,196(1):202-206.
[18]张际青,王勇,张建忠,等.超声引导经皮穿刺辅助输尿管软镜治疗肾盏憩室结石(附9例报告)[J].中国内镜杂志,2016,22(4):90-94.[18]ZHANG J Q,WANG Y,ZHANG J Z,et al.Flexible ureteroscope for management of renal calyceal diverticulum calculi with ultrasound guided puncture(9 cases)[J].China Journal of Endoscopy,2016,22(4):90-94.Chinese
[2]ARSLAN B,AKBULUT M F,ONUK O,et al.A comparison of Amplatz dilators and metal dilators for tract dilatation in minipercutaneous nephrolithotomy[J].Int Urol Nephrol,2017,49(4):581-585.
[3]ZHOU T,CHEN G,GAO X,et al.‘X-ray’-free balloon dilation for totally ultrasound-guided percutaneous nephrolithotomy[J].Urolithiasis,2015,43(2):189-195.
[4]SHAH A K,XU K,LIU H,et al.The“visual dilator system”:initial experimental evaluation of an optical tract dilation technique in percutaneous nephrolithotomy[J].J Endourol,2013,27(7):908-913.
[5]ZIAEE S A,KARAMI H,AMINSHARIFI A,et al.One-stage tract dilation for percutaneous nephrolithotomy:is it justified[J].JEndourol,2007,21(12):1415-1420.
[6]YANG H,LI J,LONG G,et al.The application of a novel integrated rigid and flexible nephroscope in percutaneous nephrolithotomy for renal staghorn stones[J].BMC Urology,2017,17(1):67.
[7]张际青,张军晖,康宁,等.自制F4.85可视穿刺针联合输尿管通道鞘在超微经皮肾镜碎石术中的应用[J].中华泌尿外科杂志,2017,38(11):852-856.[7]ZHANG J Q,ZHANG J H,KANG N,et al.Effect of microperc for treatment of renal calculi with self-made optical puncture needle combined with ureteral access sheath[J].Chin J Urol,2017,38(11):852-856.Chinese
[8]NOURALIZADEH A,SHARIFIAGHDAS F,PAKMANESH H,et al.Fluoroscopy-free ultrasonography-guided percutaneous nephrolithotomy in pediatric patients:a single-center experience[J].World J Urol,2018,36(4):667-671.
[9]ZHANG J Q,WANG Y,ZHANG J H,et al.Retrospective analysis of ultrasound-guided flexible ureteroscopy in the management of calyceal diverticular calculi[J].Chinese Medical Journal,2016,129(17):2067-2073.
[10]SRIVASTAVA A,SINGH S,DHAYAL I R,et al.A prospective randomized study comparing the four tract dilation methods of percutaneous nephrolithotomy[J].World J Urol,2017,35(5):803-807.
[11]JOEL A B,RUBENSTEIN J N,HSIEH M H,et al.Failed percutaneous balloon dilation for renal access:incidence and risk factors[J].Urology,2005,66(1):29-32.
[12]DEHONG C,LIANGREN L,HUAWEI L,et al.A comparison among four tract dilation methods of percutaneous nephrolithotomy:a systematic review and meta-analysis[J].Urolithiasis,2013,41(6):523-530.
[13]NALBANT I,KARAKOYUNLU A N,YESIL S,et al.Comparison of dilation methods in percutaneous nephrolithotomy:which one is more successful[J].J Laparoendosc Adv Surg Tech A,2016,26(6):478-482.
[14]TSAI Y S,JOU Y C,SHEN C H,et al.Antegrade ureteroscopic assistance during percutaneous nephrolithotomy for complete renal staghorn stone:technique and outcomes[J].Urological Science,2015,26(1):61-64.
[15]TURNA B,NAZLI O,DEMIRYOGURAN S,et al.Percutaneous nephrolithotomy:variables that influence hemorrhage[J].Urology,2007,69(4):603-607.
[16]FERRANDINO M N,BAGRODIA A,PIERRE S A,et al.Radiation exposure in the acute and short-term management of urolithiasis at 2 academic centers[J].J Urol,2009,181(2):668-672.
[17]DUDLEY A G,DWYER M E,FOX J A,et al.Prospective assessment of radiation in pediatric urology:the pediatric urology radiation safety evaluation study[J].J Urol,2016,196(1):202-206.
[18]张际青,王勇,张建忠,等.超声引导经皮穿刺辅助输尿管软镜治疗肾盏憩室结石(附9例报告)[J].中国内镜杂志,2016,22(4):90-94.[18]ZHANG J Q,WANG Y,ZHANG J Z,et al.Flexible ureteroscope for management of renal calyceal diverticulum calculi with ultrasound guided puncture(9 cases)[J].China Journal of Endoscopy,2016,22(4):90-94.Chinese