可视扩张鞘联合针状肾镜经皮肾镜手术治疗肾结石的安全性和穿刺精准度分析

Safety and puncture accuracy of visual dilated sheath combined with needle nephroscope percutaneous nephroscopy for renal calculi

摘要

目的 将传统扩张鞘改良为可视扩张鞘并比较其联合针状肾镜经皮肾镜取石术（PCNL）与传统PCNL治疗肾结石的临床效果，为提高术中安全性和穿刺精确度提供参考。方法 回顾性分析2022年9月-2023年9月安徽省立医院涡阳分院泌尿外科收治的100例肾结石患者的临床资料，其中52例患者行可视扩张鞘联合针状肾镜PCNL（针状肾镜组），48例患者行传统PCNL（传统组），比较两组患者的临床资料及手术疗效。结果 两组患者的一般资料、总手术时间、住院时间比较，差异无统计学意义（P＞0.05）。针状肾镜组较传统组的通道建立时间更长[20.0（17.0～22.0）min vs.16.0（15.0～21.0）min，P=0.002]，穿刺时间更短[2.0（1.0～2.6）min vs.2.8（2.0～3.5）min，P＜0.001]，调针次数1次以上者占比更少（9.6% vs.64.6%，P＜0.001）。针状肾镜组中所有患者的通道均1次建立成功，而传统组中通道共建立次数1次者41例、2次者6例、3次者1例。针状肾镜组的患者无术后严重并发症发生，传统组中1例患者出现术后出血，行介入治疗后病情好转。针状肾镜组和传统组术后Ⅰ期结石清除率比较，差异无统计学意义（88.4% vs.85.4%，P=0.872）。结论 可视扩张鞘联合针状肾镜PCNL与传统PCNL的Ⅰ期结石清除率相似，但前者穿刺时间更短、调针次数更少、术后并发症发生率低，在安全性和穿刺精准度上更具优势。

Abstract

Objective To compare the clinical efficacy of visual dilated sheath combined with needle nephroscope percutaneous nephrolithotomy (PCNL) with traditional PCNL for renal calculi, so as to enhance the intraoperative safety and puncture accuracy. Methods A retrospective analysis was conducted on 100 patients with renal calculi treated on hospital during Sep. 2022 to Sep. 2023. Based on the surgical approaches, patients were divided into the needle nephroscope group (PCNL with visual dilator sheath and needle nephroscope, n=52) and traditional group (traditional PCNL, n=48). Clinical characteristics, surgical parameters, and outcomes were compared between the two groups. Results There were no significant differences between the two groups in baseline data, total operation time and hospital stay (P>0.05). The needle nephroscope group had a longer channel establishment time compared to the traditional group [20.0 (17.0-22.0) min vs. 16.0 (15.0-21.0) min, P=0.002], but significantly shorter puncture time [2.0 (1.0-2.6) min vs. 2.8 (2.0-3.5) min, P<0.001], and fewer adjustments of the puncture needle (9.6% vs. 64.6%, P<0.001). The channel was successfully established on the first attempt in all patients in the needle nephroscope group, while only 41 of patients in the traditional group achieved success on the first attempt, 6 cases needed 2 attempts, and 1 case needed 3 attempts. Postoperative complications were absent in the needle nephroscope group, whereas postoperative bleeding requiring interventional treatment occurred in 1 case in the traditional group. There was no significant difference in the first-stage stone-clearance rate between the two groups (88.4% vs. 85.4%, P=0.872). Conclusion PCNL using a visual dilator sheath combined with a needle nephroscope achieves a comparable first-stage stone-clearance rate to traditional PCNL. However, it offers significant advantages in terms of shorter puncture time, fewer adjustments of the puncture needle, and lower postoperative complication rate. These findings suggest superior safety and precision, making it a valuable technique for clinical application.

关键词

经皮肾镜取石术 / 可视穿刺 / 可视扩张 / 针状肾镜 / 肾结石

Key words

percutaneous nephrolithotomy / visual puncture / visual dilation / Needle-perc / renal calculi

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基金资助

亳州市卫生健康委员会市级科研项目(bzwj2022b025)