新型连续灌注可调负压清石鞘装置在经皮肾镜取石术中的应用

Application of a novel variable-mini-percutaneous nephrolithotomy system for percutaneous nephrolithotomy

摘要:

目的 评估新型连续灌注可调负压清石鞘（VMP）装置在经皮肾镜取石术（PCNL）中的安全性和可行性，探讨其碎石、清石效率和优势。方法 回顾性分析2016年1月－2021年2月解放军总医院海南医院64例行PCNL治疗的肾结石患者的临床资料。根据治疗方案不同分为VMP组（n = 36）和常规PCNL组（SP组，n = 28）。所有患者均于麻醉后在超声引导穿刺下逐步扩张，建立（F16～F20）经皮肾通道，使用VMP装置（VMP组）或常规经皮肾装置（SP组）行钬激光碎石。比较两组患者围手术期指标和清石率（SFR）等。结果 所有患者均顺利完成手术。VMP组术中平均灌注时间明显短于SP组［（42.72±29.11）和（74.82±37.33）min，P = 0.000］，SFR明显高于SP组（94.4%和75.0%，P = 0.035）。VMP组术后24 h血红蛋白（Hb）变化为11.00（5.00，11.25）g/L，SP组为3.00（-3.75，13.75）g/L，差异有统计学意义（P = 0.005），术后住院时间明显短于SP组［（7.56±2.65）和（9.21±3.26）d］，差异有统计学意义（P = 0.028）。两组患者术后24 h白细胞（WBC）和血清肌酐（SCr）变化比较，差异无统计学意义（P > 0.05）。结论 PCNL术中使用VMP安全、可行且有效，较常规PCNL能明显缩短术中灌注时间和术后住院时间，减轻术后疼痛，降低感染风险。

Abstract:

Objective To assess the effectiveness, safety, feasibility and advantages of novel variable-mini-percutaneous nephrolithotomy (VMP) in PCNL.Methods Clinical date of 64 patients with kidney stones who received PCNL from January 2016 to February 2021 were retrospectively analyzed. The patients were divided into VMP group (n = 36) and SP group (n = 28). All procedures were performed under ultrasound guided puncture to establish a F16 ~ F20 percutaneous renal access. Holmium laser was used with VMP system (VMP group) or standard PCNL (SP group). The perioperative indexes and stone-free rate (SFR) were collected and compared between the two groups.Results All the operations were performed successfully. The average irrigation time in VMP group was significant shorter than that of SP group [(42.72 ± 29.11) min vs (74.82 ± 37.33) min, P = 0.000], the SFR in VMP group was significant higher than that of SP group (94.4% vs 75.0%, P = 0.035), the post-operative 24 h hemoglobin (Hb) change in VMP group was 11.00 (5.00，11.25) g/L, SP group was 3.00 (-3.75，13.75) g/L, there was a significant statistically difference between the two groups (P = 0.005), and post-operative hospitalization duration in VMP group significant shorter than that of SP group [(7.56 ± 2.65) d vs (9.21 ± 3.26) d, P = 0.028]. There were no statistically differences in post-operative 24 h white blood cell (WBC) and serum creatinine (SCr) between the two group (P > 0.05).Conclusion VMP can be feasibly, safely, and effectively performed in PCNL, compared with conventional PCNL, it can significantly shorten intraoperative perfusion time and postoperative hospital stay, relieve postoperative pain and reduce the risk of infection.