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目的:比较F20Peel-away塑料鞘与F24标准金属外鞘应用于肾镜取石中的安全性与有效性。方法:2010年1月~2011年4月采用标准肾镜单通道治疗肾结石或输尿管结石66例,应用Wolf F24标准金属外鞘建立皮肾通道碎石42例,应用F20经皮肾塑料鞘(COOK公司)建立皮肾通道24例。俯卧位B超引导下选取目标肾盏穿刺,筋膜扩张器逐步扩张,应用F24标准金属外鞘或F20塑料鞘建立皮肾通道,置入Wolf F20.8标准肾镜,应用Cyberwand双导管碎石清石系统或EMS气压弹道碎石机进行碎石,对两组的一期结石清除率、手术时间、并发症进行比较分析。结果:66例均一期成功建立经皮肾通道。两组一期结石清除率分别为88.1%(37/42)与87.5%(21/24),手术时间分别为(78.6±12.5)min与(73.4±9.2)min,术后发热分别为6例和3例,均差异无统计学意义(P>0.05);均无输血治疗者。结论:F20Peelaway塑料鞘与F24标准金属外鞘在一期结石清除率、手术时间、并发症方面差异无统计学意义,F20塑料鞘可顺利置入F20.8标准肾镜操作,可以取出F24金属鞘无法取出的大块结石,通道不易丢失,对肾脏创伤相对小,是经皮肾镜取石中的一种新方法。
Objective: To compare the safety and effectiveness of F20 Peel-away plastic sheath and F24 standard metal sheath in the nephrolithotomy. Methods: From January 2010 to April 2011, 66 cases of nephrolithiasis or ureteral calculi were treated with standard nephrolithotomy, and 42 cases of percutaneous nephrostomy were established with Wolf F24 standard metal sheath. F20 percutaneous nephrosclerosis plastic sheath COOK company) to establish 24 cases of renal access. Under the guidance of prone position B, the target renal calixion was selected and the fascia dilator was gradually expanded. The renal access was established with F24 standard metal sheath or F20 plastic sheath, and placed into Wolf F20.8 standard nephroscope. The application of Cyberwand double catheter gravel Clear stone system or EMS pneumatic lithotripsy lithotripsy, the first group of stones clearance rate, operative time, complications were compared. Results: Percutaneous renal pathway was successfully established in 66 cases. The stone clearance rates of the two groups were 88.1% (37/42) and 87.5% (21/24) respectively, and the operative time was (78.6 ± 12.5) min and (73.4 ± 9.2) min respectively. The postoperative fever was 6 And 3 cases, the difference was not statistically significant (P> 0.05); no blood transfusion treatment. Conclusion: F20 Peelaway plastic sheath and F24 standard metal sheath in a stone clearance rate, operation time, complications were not statistically different, F20 plastic sheath can be successfully placed F20.8 standard nephrolithotomy, can be taken out of F24 metal sheath Large stones can not be removed, the channel is not easy to lose, the trauma to the kidney is relatively small, is a new method of percutaneous nephrolithotomy stone.