Safak Mut, Gögüş Cagatay, Soygür Tarkan
Department of Urology, Ankara University, School of Medicine, Ankara, Turkey.
Urol Int. 2003;71(4):382-4. doi: 10.1159/000074090.
Nephrostomy tract dilation is one of the important steps of percutaneous renal surgery. In this study, we present our initial experience with the balloon dilator in 95 patients and compare our results retrospectively with a group of 30 patients in whom Amplatz dilators were used.
The medical records of 95 patients who underwent percutaneous renal operations, including percutaneous nephrolithotomy and antegrade endopyelotomy, between September 1999 and September 2002 were reviewed. All procedures were performed using balloon dilators. The operative technique is the same as the other dilation procedures. Thirty consecutive patients who had previously undergone percutaneous renal surgery using the Amplatz dilators were taken as the control group and their charts were reviewed retrospectively, and the results compared with the results of patients in whom balloon dilation was used.
There were no major perioperative complications or deaths in both groups. The mean operative time and tract formation times for the balloon dilation group and the Amplatz dilation group were 106.8 +/- 41.4 and 11.2 +/- 3.0, and 116.4 +/- 23.7 and 16.3 +/- 2.4 min, respectively. Thirteen (13.7%) patients had significant bleeding and required blood transfusion in the balloon dilation group, whereas 5 (16.6%) patients had significant bleeding in the Amplatz dilation group. Collecting system perforation due to too far advancement of the dilator occurred in 11 (11.6%) patients but there was no major parenchymal or vascular injury medially in the balloon dilation group. On the other hand, collecting system perforation occurred during sequential Amplatz dilation in 5 (16.6%) patients.
We believe that the balloon system allows one-step dilation and shortens the dilation procedure. It may minimize bleeding which can occur during the stepwise fascial dilation. When using fascial dilators it is sometimes possible to go out of the collecting system by changing the size of the dilators. We think that balloon dilation may prevent these intraoperative and time-consuming situations.
肾造瘘通道扩张是经皮肾手术的重要步骤之一。在本研究中，我们介绍了使用球囊扩张器对95例患者的初步经验，并将结果与一组30例使用安普拉斯扩张器的患者进行回顾性比较。
回顾了1999年9月至2002年9月期间95例行经皮肾手术（包括经皮肾镜取石术和顺行肾盂内切开术）患者的病历。所有手术均使用球囊扩张器。手术技术与其他扩张手术相同。选取30例此前使用安普拉斯扩张器行过经皮肾手术的患者作为对照组，回顾其病历，并将结果与使用球囊扩张的患者结果进行比较。
两组均无围手术期重大并发症或死亡。球囊扩张组和安普拉斯扩张组的平均手术时间和通道形成时间分别为106.8±41.4分钟和11.2±3.0分钟，以及116.4±23.7分钟和16.3±2.4分钟。球囊扩张组有13例（13.7%）患者出现严重出血并需要输血，而安普拉斯扩张组有5例（16.6%）患者出现严重出血。扩张器推进过深导致集合系统穿孔在球囊扩张组有11例（11.6%）患者发生，但该组内侧未发生重大实质或血管损伤。另一方面，在安普拉斯扩张器逐次扩张过程中，集合系统穿孔在5例（16.6%）患者中发生。
我们认为球囊系统可实现一步扩张并缩短扩张过程。它可将逐步筋膜扩张过程中可能发生的出血降至最低。使用筋膜扩张器时，有时可能因更换扩张器尺寸而穿出集合系统。我们认为球囊扩张可避免这些术中及耗时的情况。
