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目的比较微通道和标准通道在经皮肾取石术(PCNL)中的效果及安全性。方法 2008年8月至2009年6月,我院采用C-型臂X光引导穿刺,微通道(14～18F)和标准通道(20～24F)两种不同PCNL通道行经皮肾取石术治疗肾内结石67例,其中微通道组31例,标准通道组36例;男性39例、女性28例,年龄31～67岁,平均46.3岁;左肾结石40例,右肾结石27例;根据腹部KUB测量结石大小:纵径2.0～6.8cm,横径1.5～5.4cm。对两组患者一期结石清除率、手术时间、手术并发症等指标进行比较。结果两组患者分别成功建立微通道和标准通道一期行单通道经皮肾碎石取石术。微通道(14～18F,本组为16～18F)组31例,标准通道(20～24F,本组为22～24F)组36例。结石清除率分别为67.7%(21/31)和88.9%(32/36),P<0.05;手术时间分别为93±17.5min和82±12.1min,P<0.05;术后发热(体温≥38.5℃)分别为25.8%(8/31)和5.6%(2/36),P<0.05;术中出血>800ml分别为3.2%(1/31)和2.8%(1/36),P>0.05;住院时间分别为7.3±0.4d和7.1±0.6d,P>0.05。结论本组研究结果显示,采用标准通道,运用8/9.8FWolf输尿管硬镜或李逊肾镜与U-100双频双脉冲激光碎石机治疗直径≥2cm的肾内结石比采用微通道具有清石效率高、手术时间短、术后发热发生率少等优点,与微通道相比,不增加术中术后出血、穿孔等并发症发生率。
Objective To compare the efficacy and safety of microchannels and standard channels in percutaneous nephrolithotomy (PCNL). Methods From August 2008 to June 2009, C-arm X-ray guided puncture, percutaneous nephrolithotomy was performed in two different PCNL channels, microchannels (14-18F) and standard channels (20-24F) 67 cases of internal stones, of which 31 cases of microchannel group, the standard access group of 36 cases; 39 males and 28 females, aged 31 to 67 years, mean 46.3 years; 40 cases of left kidney stones, right kidney stones in 27 cases; KUB measurement of stone size: longitudinal diameter 2.0 ~ 6.8cm, diameter 1.5 ~ 5.4cm. Two groups of patients with a stone clearance rate, operation time, surgical complications and other indicators were compared. Results Two groups of patients were successfully established micro-channel and standard channel one-stage percutaneous nephrolithotomy. There were 31 cases in microchannel (14 ~ 18F, 16 ~ 18F in this group) and 36 cases in standard channel (20 ~ 24F in this group, 22 ~ 24F). The stone clearance rate was 67.7% (21/31) and 88.9% (32/36) respectively, P <0.05; the operation time was 93 ± 17.5min and 82 ± 12.1min, P <0.05; postoperative fever (body temperature ≥38.5 ℃) were 25.8% (8/31) and 5.6% (2/36) respectively, P <0.05; the intraoperative blood loss> 800ml was 3.2% (1/31) and 2.8% ; Hospitalization time was 7.3 ± 0.4d and 7.1 ± 0.6d, P> 0.05. Conclusion The results of this study show that the use of standard channels, the use of 8 / 9.8FWolf ureteroscopy or Li Xun Renoscopy and U-100 dual-frequency dual-pulse laser lithotripsy treatment of renal stones ≥ 2cm in diameter than the use of microchannels with clear High efficiency of stone, shorter operation time and less incidence of postoperative fever. Comparing with microchannel, it does not increase the incidence of intraoperative and postoperative bleeding, perforation and other complications.