Zhou Tie, Chen Guanghua, Gao Xiaofeng, Zhang Wei, Xu Chuanliang, Li Lei, Sun Yinghao
Department of Urology, Changhai Hospital, The Second Military Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China,
Urolithiasis. 2015 Apr;43(2):189-95. doi: 10.1007/s00240-015-0755-7. Epub 2015 Feb 6.
The objective of the study was to evaluate the feasibility and safety of balloon dilation for 'X-ray'-free ultrasound-guided percutaneous nephrolithotomy (PCNL). From January 2012 to December 2012, patients underwent 'X-ray'-free ultrasound-guided PCNL with Amplatz dilator (Group A). From January 2013 to April 2014, patients underwent 'X-ray'-free ultrasound-guided PCNL with balloon dilator (Group B). For balloon dilation, a 10 F fascial dilator was used to dilate the tract. Subsequently, the 6 F nephrostomy balloon (8 mm in diameter) was indwelled along the guidewire with a marked length equal to the dilation depth. Under the monitoring of ultrasound, the location of balloon was secured and disappearance of balloon waist was confirmed when the balloon was inflated at a pressure of 20 atm. A total of 163 patients were involved in this study. Of 81 procedures in Group A, 45 procedures were performed by a senior urologist while 36 procedures by a resident. Of 82 patients in Group B, 47 procedures were performed by the same senior urologist while 35 procedures by another resident. For the senior urologist, there was no statistically significant difference between two groups in calyx of entry, stone-free rate, decline of hemoglobin and hematocrit, operation time and hospitalization. But for the residents, there was less decline of hemoglobin and hematocrit, tract development time and hospitalization in Group B compared to Group A (0.6 vs. 1.7 g/dl, p = 0.001; 2.3% vs. 5.5%, p = 0.003; 10.1 vs. 11.0 min, p = 0.027; 7.8 vs. 13.9 days, p < 0.001). Balloon dilation method introduced in this study is compensable for tract development when 'X-ray'-free ultrasound-guided PCNL is performed. Modified techniques make totally ultrasound guidance for PCNL feasible, easy and safe. In addition, such a procedure is preferable for initial operators because of less hemorrhage complication.
本研究的目的是评估无X线超声引导下经皮肾镜取石术（PCNL）中球囊扩张术的可行性和安全性。2012年1月至2012年12月，患者接受了使用Amplatz扩张器的无X线超声引导下PCNL（A组）。2013年1月至2014年4月，患者接受了使用球囊扩张器的无X线超声引导下PCNL（B组）。对于球囊扩张，使用10F筋膜扩张器扩张通道。随后，将6F肾造瘘球囊（直径8mm）沿导丝置入，其标记长度等于扩张深度。在超声监测下，确保球囊位置正确，当球囊在20个大气压下充气时确认球囊腰部消失。本研究共纳入163例患者。A组的81例手术中，45例由资深泌尿外科医生完成，36例由住院医生完成。B组的82例患者中，47例由同一位资深泌尿外科医生完成，35例由另一位住院医生完成。对于资深泌尿外科医生而言，两组在进入肾盏、结石清除率、血红蛋白和血细胞比容下降、手术时间和住院时间方面无统计学显著差异。但对于住院医生来说，与A组相比，B组的血红蛋白和血细胞比容下降、通道建立时间和住院时间更少（0.6 vs. 1.7g/dl，p = 0.001；2.3% vs. 5.5%，p = 0.003；10.1 vs. 11.0分钟，p = 0.027；7.8 vs. 13.9天，p < 0.001）。本研究中引入的球囊扩张方法在进行无X线超声引导下PCNL时可弥补通道建立的不足。改良技术使PCNL完全在超声引导下可行、简便且安全。此外，由于出血并发症较少，该手术对初手术者更可取。
