12肋尖上2cm区域PCNL术治疗鹿角形肾结石的临床效果分析
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摘要
目的探究12肋尖上2cm区域经皮肾镜取石术(PCNL)治疗鹿角型肾结石的临床疗效及安全性。方法分析该科2016年8月—2018年3月入院行PCNL术的鹿角形肾结石患者120例,观察组60例,经皮肾通道穿刺点选择12肋尖上2 cm区域(简称肋尖上通道),对照组60例,经皮肾通道(简称肋下通道)穿刺点选择12肋下范围,比较两组手术患者一期结石清除率、手术时间、术中出血量、术后住院时间、术后肾出血需要介入栓塞例数。结果观察组的结石清除率(88.3%)高于对照组(75.0%),两组比较差异有统计学意义(χ~2=5.13,P<0.05);但相对于对照组的手术时间(99.77±19.68)min、术中出血量(319.51±43.2)mL、术后住院时间(8.17±2.01)d及术后肾出血需要介入栓塞的例数(7例),观察组的手术时间(90.12±17.21)min、术中出血量(251.50±31.37)mL、术后住院时间(5.57±1.63)d及术后肾出血需要介入栓塞的例数(1例)均明显低于对照组,两组差异有统计学意义(t=2.857、9.867,7.77,χ~2=4.82,P<0.05)。结论 12肋尖上2 cm区域行经皮肾镜取石术是安全的。与肋下通道相比,具有结石清除效率高、手术时间短、术中出血少及术后恢复快等优点。
Objective To investigate the clinical efficacy and safety of percutaneous nephrolithotomy(PCNL) in the treatment of staghorn type kidney stones in the 2 cm region. Methods A total of 120 patients with staghorn kidney stones admitted to the hospital from August 2016 to March 2018, and 60 patients in the observation group were selected. The percutaneous renal channel puncture site was selected from the 12 rib tip 2 cm area(referred to as the rib tip channel). 60 cases in the control group, the percutaneous renal channel(referred to as the subcostal channel) puncture point was selected under the 12-ribbed range, comparing the first-stage stone removal rate, operation time, intraoperative blood loss, postoperative hospital stay, surgery postoperative renal hemorrhage requires interventional embolization.Results The stone clearance rate(88.3%) in the observation group was higher than that in the control group(75.0%).The difference between the two groups was statistically significant(χ~2=5.13, P<0.05). However, the operation time was compared with the control group(99.77±19.68)min, intraoperative blood loss(319.51±43.2)mL, postoperative hospital stay(8.17±2.01)d and postoperative renal hemorrhage requiring interventional embolization(7 cases), observation group operation time(90.12±17.21)min, the number of intraoperative blood loss(251.50±31.37)mL, postoperative hospital stay(5.57±1.63)d and postoperative renal hemorrhage requiring interventional embolization(1 case) were significantly lower than the control group. Academic significance(t =2.857, 9.867, 7.77, χ~2=4.82, P <0.05). Conclusion Percutaneous nephrolithotomy is safe in the 2 cm area of the rib. Compared with the subcostal channel, it has the advantages of high stone removal efficiency, short operation time, less intraoperative blood loss and quick postoperative recovery.
Objective To investigate the clinical efficacy and safety of percutaneous nephrolithotomy(PCNL) in the treatment of staghorn type kidney stones in the 2 cm region. Methods A total of 120 patients with staghorn kidney stones admitted to the hospital from August 2016 to March 2018, and 60 patients in the observation group were selected. The percutaneous renal channel puncture site was selected from the 12 rib tip 2 cm area(referred to as the rib tip channel). 60 cases in the control group, the percutaneous renal channel(referred to as the subcostal channel) puncture point was selected under the 12-ribbed range, comparing the first-stage stone removal rate, operation time, intraoperative blood loss, postoperative hospital stay, surgery postoperative renal hemorrhage requires interventional embolization.Results The stone clearance rate(88.3%) in the observation group was higher than that in the control group(75.0%).The difference between the two groups was statistically significant(χ~2=5.13, P<0.05). However, the operation time was compared with the control group(99.77±19.68)min, intraoperative blood loss(319.51±43.2)mL, postoperative hospital stay(8.17±2.01)d and postoperative renal hemorrhage requiring interventional embolization(7 cases), observation group operation time(90.12±17.21)min, the number of intraoperative blood loss(251.50±31.37)mL, postoperative hospital stay(5.57±1.63)d and postoperative renal hemorrhage requiring interventional embolization(1 case) were significantly lower than the control group. Academic significance(t =2.857, 9.867, 7.77, χ~2=4.82, P <0.05). Conclusion Percutaneous nephrolithotomy is safe in the 2 cm area of the rib. Compared with the subcostal channel, it has the advantages of high stone removal efficiency, short operation time, less intraoperative blood loss and quick postoperative recovery.
引文
[1]周立权,农振良,邓耀良,等.经不同肾盏单通道行经皮肾镜碎石取石术的疗效比较[J].重庆医科大学学报,2018,43(4):579-582.
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[11]张忠君.对比探析肋上通道与肋下通道经皮肾镜取石术用于治疗鹿角形肾结石的临床疗效[J].中国医药指南,2018,16(12):65-66.
[12]Patel AP, Bui D, Pattaras J, et al.Upper pole urologi stobtained percutaneous renal access for PCNL is safe and efficacious[J].Can J Urol,2017,24(2):8754-8758.
[13]Renato N,PedroMD, Nelson Rodrigues. Upper-Pole Access for Percutaneous nephrolithotomy[J].J Endourol,2009(23):1645-1647.
[14]张晶.肋上通道经皮肾镜取石术的应用解剖及临床应用研究[D].石家庄:河北大学,2012.
[2]刘鹏华,陈云峰,刘向崇,等.输尿管镜钬激光碎石术与经皮肾镜碎石术治疗输尿管上段结石的比较研究[J].青岛医药卫生,2018,50(2):94-96.
[3]李柏均,高志远,向慧,等.预置输尿管支架管制造人工肾积水在经皮肾镜取石术中的应用效果[J].广西医学,2018,40(3):332-334.
[4]杨杰,尹勇,聂明,蒋理海,王坤杰.超声引导下经上盏入路经皮肾镜治疗鹿角形肾结石疗效分析[J].四川大学学报:医学版,2017,48(2):324-325.
[5]杨文增,张晶,赵春利,等.肋上通道经皮肾镜取石术治疗鹿角形肾结石临床疗效观察[J].中国全科医学,2012,15(15):1759-1761.
[6]彭松,高小峰,彭泳涵,等.超声引导下经肋上入路肾上盏单通道经皮肾镜治疗鹿角形肾结石[J].第二军医大学学报,2013,34(9):1025-1028.
[7]Basiri A, Kashi AH, Zeinali M.et al.Ultrasound-guided access during percutaneous nephrolithotomy:entering desired calyx with appropriate entry site and angle[J].Int Braz J Urol,2016,42(6):1160-1167.
[8]熊焕腾,曾涛,朱遵伟.肾中盏入路经皮肾镜取石术治疗继发中重度肾积水的输尿管上段结石或肾盂结石[J].山东医药,2018,58(3):83-85.
[9]温韶强,闫伟.肋上通道与肋下通道经皮肾镜取石术对鹿角形肾结石治疗比较[J].中国实用医药,2015,10(22):53-54.
[10]刘恬.肋上通道经皮肾镜取石术在鹿角形肾结石治疗中的应用价值分析[J].黑龙江医学,2014,38(11):1267-1268.
[11]张忠君.对比探析肋上通道与肋下通道经皮肾镜取石术用于治疗鹿角形肾结石的临床疗效[J].中国医药指南,2018,16(12):65-66.
[12]Patel AP, Bui D, Pattaras J, et al.Upper pole urologi stobtained percutaneous renal access for PCNL is safe and efficacious[J].Can J Urol,2017,24(2):8754-8758.
[13]Renato N,PedroMD, Nelson Rodrigues. Upper-Pole Access for Percutaneous nephrolithotomy[J].J Endourol,2009(23):1645-1647.
[14]张晶.肋上通道经皮肾镜取石术的应用解剖及临床应用研究[D].石家庄:河北大学,2012.