Frattini A, Barbieri A, Salsi P, Sebastio N, Ferretti S, Bergamaschi E, Cortellini P
Division of Urology, Hospital of Parma, Italy.
J Endourol. 2001 Nov;15(9):919-23. doi: 10.1089/089277901753284143.
The creation of the nephrostomy access is a fundamental step of percutaneous nephrolithotripsy (PCNL). Dilation of the track is usually achieved with multiple incremental flexible exchange dilators of the Amplatz type, metal telescoping dilators of the Alken type, or a balloon. Currently, balloon dilation is regarded as the most modern and safest system, though it has the disadvantage of relatively high cost. The aim of this study was to demonstrate that a procedure that we named "one shot," which consists of a single dilation of the track with a 25F or 30F Amplatz dilator, compares favorably in terms of efficacy, costs, and length with the other techniques of track dilation, without a significant increase in morbidity.
Seventy-eight consecutive patients who underwent PCNL for stone disease from June 1998 to July 1999 were considered and divided into three groups according to the type of tract dilation used: A (Alken telescoping dilators), B (balloon), or C (one shot). Radiologic exposure, blood loss, and costs were evaluated.
The one-shot procedure compared favorably with both of the other dilation techniques without an increase in morbidity and with significant reductions in X-ray exposure and costs. Indeed, significant differences in estimated blood loss were observed between groups B and C and the minor bleeding for group C.
Our experience indicates that one-shot dilation is feasible in the majority of patients. It is as safe and effective as the technique regarded today as the gold standard but less time consuming and less expensive. These encouraging results should be confirmed by further studies.
建立肾造瘘通道是经皮肾镜取石术（PCNL）的基本步骤。通道扩张通常使用多种递增式的安普拉斯（Amplatz）型柔性交换扩张器、阿尔肯（Alken）型金属伸缩扩张器或球囊来完成。目前，球囊扩张被认为是最现代且最安全的系统，尽管其缺点是成本相对较高。本研究的目的是证明一种我们称为“单次扩张”的方法，即使用25F或30F安普拉斯扩张器对通道进行单次扩张，在疗效、成本和操作时长方面与其他通道扩张技术相比具有优势，且不会显著增加并发症发生率。
纳入1998年6月至1999年7月期间连续78例因结石疾病接受PCNL的患者，并根据所使用的通道扩张类型分为三组：A组（阿尔肯伸缩扩张器）、B组（球囊）或C组（单次扩张）。评估了放射学暴露、失血量和成本。
单次扩张方法与其他两种扩张技术相比具有优势，并发症发生率未增加，且X线暴露和成本显著降低。事实上，B组和C组之间在估计失血量上存在显著差异，C组有少量出血。
我们研究显示单次扩张在大多数患者中是可行的。它与当今被视为金标准的技术一样安全有效，但耗时更短且成本更低。这些令人鼓舞的结果应通过进一步研究加以证实。
