单通道与多通道经皮肾镜取石术中肾盂内压变化及临床疗效

摘要

目的 探讨建立单通道和多通道在经皮肾镜取石术(PCNL)中肾盂内压力变化及临床疗效.方法 回顾性分析南京军区南京总医院2012年5月至2016年3月收治的复杂性肾结石304例患者临床资料,其中接受单通道PCNL的160例作为单通道组,接受多通道PCNL的144例作为多道通组(双通道101例,三通道39例,四通道4例),观察比较2组患者手术时间、住院时间、结石清除率和发生感染例数等.通过逆行置入肾盂的F6输尿管导管连接测压系统,监测不同数目通道下PCNL中肾盂内压的变化.结果 单通道、双通道、三通道以及四通道下PCNL术中平均肾盂内压分别为(32.36±6.15)、(18.23±3.43)、(16.67±2.61)及(14.23±2.76)cmH2O(1 cmH2O=0.098 kPa).单通道PCNL术中平均肾盂内压均高于多通道(P<0.01),而双通道、三通道和四通道PCNL术中平均肾盂内压比较差异无统计学意义(P>0.05).2组术中出血量差异无统计学意义(P>0.05),与单通道组比,多道通组手术时间及住院时间均较短、结石清除率高、发生感染例数较少(P<0.05).结论 与单通道相比,采用多通道法微创经皮肾镜碎石取石术可提高复杂性肾结石的清石率,降低术后并发症发生率.%Objective To study the change of renal pelvic pressure and the effect of single tract and multiple tract by holmi-um laser in percutaneous nephrolithotomy ( PCNL) . Methods From 2010 May to 2016 March, 304 complex renal calculi patients enrolled into Nanjing general hospital were randomly divided into two groups according to different methods, 160 cases in the control group who accepted single tract, and 144 cases in the observation group who accepted multiple tracts ( two tracts 101 cases,three tracts 39 cases,and four tracts 4 cases) , the effects of two groups were compared. A 6F ureteral catheter was inserted into renal pelvis and connected to the pressure monitering system. The renal pelvic pressures were recorded every one second, and the data were stored in computer for analysis. Results The average renal pelvic pressure of different number of access tract of PCNL such as single tract, two tracts, three tracts, and four tracts were (32. 36 ± 6. 15), (18. 23±3. 43), (16. 67±2. 61) and (14. 23±2. 76) cmH2O (1 cmH2O=0. 098 kPa).Renal pelvic pressure of single tract was significantly higher than that of multiple tracts (P<0. 01),but there was no difference among multiple tract (P>0. 05).There was no significant difference in the blood loss during PCNL (P>0. 05). Compared with the control group, operation time and hospital stay were decreased,the stone clearance rate was increased and the incidence of in-fection was decreased ( P<0. 05) . Conclusion Compared with single tract,multiple tracts in percutaneous nephrolithotomy by hol-mium laser can improve the efficiency of the gravel and minimally reduce the postoperative complications.