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目的:比较B超引导及B超引导+全尿路会师贯通技术建立操作通道行PCNL治疗肾结石的疗效,探讨全尿路会师贯通技术建立操作通道行PCNL的优势。方法:2008年10月～2011年10月行PCNL治疗肾结石患者115例,依据穿刺引导方法的不同分为A、B两组,其中超声引导组61例(A组),结石位于左侧27例,右侧24例,双侧10例,结石平均大小2.9(3.0±0.6)cm;超声引导+全尿路会师贯通技术组(B组)54例,结石位于左侧20例,右侧22例,结石平均大小2.8(2.9±0.6)cm。两组均扩张通道至F24,置入F22工作鞘、F20和F08肾镜,采用气压弹道及超声碎石取石,比较两组穿刺时间、穿刺成功率、并发症发生率、取石成功率(无石率+无意义残石率)。结果:穿刺时间:A组9.4(10.4±4.2)min,B组6.6(6.2±3.8)min(P>0.05);一次穿刺成功率:A组73.7%(45/61),B组94.4%(51/54)(P<0.05);并发症发生率:A组16.4%(10/61),B组5.0%(2/54);取石成功率:A组80.3%(49/61),B组92.5%(50/54)。结论:B超引导+全尿路会师贯通术建立操作通道行PCNL可明显提高PCNL手术效率,减少并发症的发生。
OBJECTIVE: To compare the curative effect of B-guided ultrasonography and B-guided + all-urinary metacarpophalactomy technique to establish PCNL for the treatment of nephrolithiasis, and to explore the advantages of PCNL in establishing all-access pathway through PCL. Methods: From October 2008 to October 2011, 115 patients with PCNL were treated with PCNL. According to the different methods of puncture, A and B were divided into two groups, of which 61 were ultrasound guided group (group A), the stones were located on the left 27 Cases of right side in 24 cases, both sides of the 10 cases, the average size of stones 2.9 (3.0 ± 0.6) cm; ultrasound guided + whole urinary tract access through the technical group (B group) 54 cases, stones in the left side of the 20 cases, the right side of 22 For example, the average size of stones is 2.8 (2.9 ± 0.6) cm. Both groups were expanded to F24, placed in F22, F20 and F08 nephrolithotomy. Pneumatic lithotripsy and ultrasonic lithotripsy were performed. The puncture time, puncture success rate, complication rate, stone success rate (without stone Rate + meaningless residual stone rate). Results: The time of puncture was 9.4 (10.4 ± 4.2) min in group A and 6.6 (6.2 ± 3.8) min in group B (P> 0.05). The successful rate of puncture was 73.7% (45/61) in group A and 94.4% The incidence of complications was 16.4% (10/61) in group A and 5.0% (2/54) in group B. The success rate of stone extraction was 80.3% (49/61) in group A, Group 92.5% (50/54). Conclusion: B-guided + full urinary tract division through the establishment of operation channel PCNL can significantly improve the efficiency of PCNL surgery and reduce the incidence of complications.