标准通道与微创经皮肾镜取石术在不同肾盂压力下治疗鹿角形肾结石比较
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摘要
目的探讨肾盂压力监测下,20F、22F标准通道与16F、18F微通道经皮肾镜取石术治疗鹿角形肾结石的临床疗效。方法选取从2015年1月至2017年10月确诊鹿角形肾结石患者185例,随机分为16 F、18 F、20 F、22 F通道组,依据术中肾盂内压力≥30 mm Hg,将通道组分为低压组与高压组。比较碎石时间、术中出血量、结石清除率、并发症的发生率。结果 (1)碎石时间:16 F、18 F通道的手术时间长于20 F、22 F通道组(P<0.05);(2)出血量:低压组的出血量低于高压组(P<0.05);(3)结石清除率:16 F及18 F通道的结石清除率低于20 F、22 F通道组,低压组的结石清除率大于高压组(P<0.05)。(4)高压组并发症的发生率高于低压组(P<0.05)。结论肾盂压力<30 mm Hg时,同16F、18F微通道相比,20 F、22 F标准通道治疗鹿角形肾结石既可提高碎石率,又可减少术后感染等并发症。
Objective To investigate the efficacy of percutaneous nephrolithotomy under renal pelvic pressure monitoring,such as 20F,22F as standard channel and 16F,18F as minimal channel in the treatment of staghorn renal calculi.Methods 185 staghorn calculi cases from January 2015 to October 2017 were randomly divided into 16F,18F,20F or 22F channel groups.Moreover,based on 30 mm Hg intrapelvic pressure and the duration of 10 minutes,the channel groups were subdivided into low pressure group and high pressure group.The time for stone clearance,intraoperative blood loss,stone clearance rate and the incidence of complications including fever,perirenal effusion and septic shock were compared among the groups.Results (1)Stone clearance time for 16F and18F channels including high and low pressure groups were longer than those of 20F and 22F groups(P<0.05);(2)The amount of bleeding in the low pressure group was lower than that in the high pressure group(P<0.05);(3)The stone clearance rates of 16F and 18F channels were lower than those of 20F and 22F channels.The stone clearance rate in the low pressure group was higher than that in the high pressure group(P<0.05).(4)The incidence of complications in the high pressure group was significantly higher than that in the low pressure group(P<0.05).Conclusion sCompared with 16F,18F minimal channels,the standard channels such as 20F and 22F can improve the rate of lithotripsy and reduce the postoperative complications under 30 mm Hg intrapelvic pressure.
Objective To investigate the efficacy of percutaneous nephrolithotomy under renal pelvic pressure monitoring,such as 20F,22F as standard channel and 16F,18F as minimal channel in the treatment of staghorn renal calculi.Methods 185 staghorn calculi cases from January 2015 to October 2017 were randomly divided into 16F,18F,20F or 22F channel groups.Moreover,based on 30 mm Hg intrapelvic pressure and the duration of 10 minutes,the channel groups were subdivided into low pressure group and high pressure group.The time for stone clearance,intraoperative blood loss,stone clearance rate and the incidence of complications including fever,perirenal effusion and septic shock were compared among the groups.Results (1)Stone clearance time for 16F and18F channels including high and low pressure groups were longer than those of 20F and 22F groups(P<0.05);(2)The amount of bleeding in the low pressure group was lower than that in the high pressure group(P<0.05);(3)The stone clearance rates of 16F and 18F channels were lower than those of 20F and 22F channels.The stone clearance rate in the low pressure group was higher than that in the high pressure group(P<0.05).(4)The incidence of complications in the high pressure group was significantly higher than that in the low pressure group(P<0.05).Conclusion sCompared with 16F,18F minimal channels,the standard channels such as 20F and 22F can improve the rate of lithotripsy and reduce the postoperative complications under 30 mm Hg intrapelvic pressure.
引文
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[8]周国保,余运旵,方小林,等.标准通道与微通道经皮肾镜碎石术治疗上尿路结石的疗效比较[J].安徽医学,2017,38(4):422-425.
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[13]路璐,李小顺,何丽萍,等.经皮肾镜碎石取石术后并发感染危险因素[J].中国感染控制杂志,2015,14(1):35-37.
[14]潘铁军,谢旭敏,李功成.不同口径通道经皮肾镜取石术与术后感染的相关性研究[J].现代泌尿外科杂志,2015,20(3):147-150.
[15]胡常华,胡晓泉,王磊.微创经皮肾镜碎石取石术的临床疗效和术中及术后出血风险因素分析[J].中华全科医学,2015,13(10):1727-1729.
[16]陈文彬,崔书平,刘飞,等.微通道经皮肾镜取石术治疗上尿路结石2724例经验总结[J].临床军医杂志,2015,43(5):509-512+515.
[17]曾鹏,吴小伟,莫鉴锋,等.微创肾镜经皮肾穿刺取石术中通道与肾盂内压变化的关系[J].国际泌尿系统杂志,2012,32(4):462-465.
[18]徐洋.经皮肾穿刺取石术标准通道与微通道在不同肾盂压力下治疗感染性肾结石的对比研究[D].山东大学,2012.
[19]钟志刚,潘铁军,李功成.F24通道和F16通道经皮肾镜取石术中肾盂内压的对比研究[J].中华泌尿外科杂志,2016,37(5):354-357.
[2]赵瑞振,高伟兴,张炜,等.微通道经皮肾镜取石术和标准通道经皮肾镜取石术的临床对比研究[J].现代生物医学进展,2015,15(21):4143-4145.
[3]K?ROGLU A,TOGAL T,CI?EK M,et al.The effects of irrigation fluid volume and irrigation time on fluid electrolyte balance and hemodynamics in percutaneous nephrolithotripsy.[J].Int Urology Nephrol,2003,35(1):1-6.
[4]马涛,杨文增,周洪月,等.标准通道辅助微通道经皮肾镜治疗肾铸型结石86例[J].实用医学杂志,2010,26(24):4623-4624.
[5]高伟,刘建平,王永忠,等.微创经皮肾取石术治疗鹿角形肾结石对肾内血流动力学影响[J].实用医学杂志,2013,29(14):2362-2364.
[6]聂坚强.经皮肾镜取石术后脓毒血症与术中灌注压的相关性研究进展[J].国际泌尿系统杂志,2016,36(5):766-769.
[7]张伟,祖雄兵,齐琳,等.微通道与标准通道经皮肾镜取石术治疗复杂性肾结石的比较[J].中国内镜杂志,2015,21(1):34-36.
[8]周国保,余运旵,方小林,等.标准通道与微通道经皮肾镜碎石术治疗上尿路结石的疗效比较[J].安徽医学,2017,38(4):422-425.
[9]那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南手册[J].2014.
[10]霍仲超,刘刚.泌尿微创技术应用中肾盂高压相关并发症的研究进展[J].中国临床新医学,2015,8(11):1110-1113.
[11]TROXEL S A,LOW R K.Renal intrapelvic pressure during percutaneous nephrolithotomy and its correlation with the development of postoperative fever[J].J Urol,2002,168(4 Pt 1):1348.
[12]吕东,黄翔,窦科,等.俯卧位与平卧位在经皮肾镜碎石取石术中的临床分析[J].实用医学杂志,2016,32(15):2486-2488.
[13]路璐,李小顺,何丽萍,等.经皮肾镜碎石取石术后并发感染危险因素[J].中国感染控制杂志,2015,14(1):35-37.
[14]潘铁军,谢旭敏,李功成.不同口径通道经皮肾镜取石术与术后感染的相关性研究[J].现代泌尿外科杂志,2015,20(3):147-150.
[15]胡常华,胡晓泉,王磊.微创经皮肾镜碎石取石术的临床疗效和术中及术后出血风险因素分析[J].中华全科医学,2015,13(10):1727-1729.
[16]陈文彬,崔书平,刘飞,等.微通道经皮肾镜取石术治疗上尿路结石2724例经验总结[J].临床军医杂志,2015,43(5):509-512+515.
[17]曾鹏,吴小伟,莫鉴锋,等.微创肾镜经皮肾穿刺取石术中通道与肾盂内压变化的关系[J].国际泌尿系统杂志,2012,32(4):462-465.
[18]徐洋.经皮肾穿刺取石术标准通道与微通道在不同肾盂压力下治疗感染性肾结石的对比研究[D].山东大学,2012.
[19]钟志刚,潘铁军,李功成.F24通道和F16通道经皮肾镜取石术中肾盂内压的对比研究[J].中华泌尿外科杂志,2016,37(5):354-357.