Department of Urology, Loma Linda University Medical Center, Loma Linda, California.
Department of Radiology, Loma Linda University Medical Center, Loma Linda, California.
J Urol. 2016 Jul;196(1):227-33. doi: 10.1016/j.juro.2016.01.118. Epub 2016 Feb 22.
Percutaneous nephrolithotomy access may be technically challenging and result in significant radiation exposure. In an attempt to reduce percutaneous nephrolithotomy radiation exposure, a novel technique combining ultrasound and direct ureteroscopic visualization was developed and reviewed.
Ureteroscopy without fluoroscopy was used to determine the optimal calyx for access, which was punctured with a Chiba needle under percutaneous ultrasound guidance. Next a wire was passed into the collecting system and ureteroscopically pulled into the ureter using a basket. Tract dilation and sheath and nephrostomy tube placement were performed under direct ureteroscopic visualization. Twenty consecutive patients undergoing this novel technique were reviewed and compared to 20 matched patients treated with conventional percutaneous nephrolithotomy. Mann-Whitney U and Pearson chi-square tests were used for comparisons with p <0.05 considered significant.
Using this novel technique mean fluoroscopy access time was 3.5 seconds (range 0 to 27.9) and mean total fluoroscopic time was 8.8 seconds (range 0 to 47.1). Mean operative time was 232 minutes (range 87 to 533), estimated blood loss was 111 ml, the stone-free rate was 65% and the complication rate was 25%. Compared to 20 matched conventional percutaneous nephrolithotomy cases, there was no difference in operative time (p=0.76), estimated blood loss (p=0.64), stone-free rate (p=0.50) or complications (p=1.00). However, the novel technique resulted in a significant reduction in fluoroscopy access time (3.5 vs 915.5 seconds, p <0.001) and total fluoroscopy time (8.8 vs 1,028.7 seconds, p <0.001).
This study demonstrates the feasibility of combined ultrasound and ureteroscopic assisted access for percutaneous nephrolithotomy. A greater than 99% reduction in fluoroscopy time was achieved using this technique.
经皮肾镜取石术的通道可能具有技术挑战性，并导致大量辐射暴露。为了降低经皮肾镜取石术的辐射暴露，开发并回顾了一种结合超声和直接输尿管镜可视化的新技术。
在没有透视的情况下使用输尿管镜确定最佳的肾盂入路，在经皮超声引导下用 Chiba 针穿刺。然后将一根线穿过收集系统，并使用篮筐经输尿管镜拉入输尿管。在直接输尿管镜可视化下进行通道扩张、鞘管和肾造口管放置。回顾性分析了 20 例接受该新技术的连续患者，并与 20 例接受传统经皮肾镜取石术治疗的患者进行了比较。使用 Mann-Whitney U 和 Pearson chi-square 检验进行比较，p<0.05 认为具有统计学意义。
使用该新技术，透视通道时间的平均值为 3.5 秒（范围 0 至 27.9），总透视时间的平均值为 8.8 秒（范围 0 至 47.1）。平均手术时间为 232 分钟（范围 87 至 533），估计失血量为 111 毫升，结石清除率为 65%，并发症发生率为 25%。与 20 例匹配的传统经皮肾镜取石术病例相比，手术时间无差异（p=0.76），估计失血量无差异（p=0.64），结石清除率无差异（p=0.50），并发症发生率无差异（p=1.00）。然而，该新技术显著减少了透视通道时间（3.5 与 915.5 秒，p<0.001）和总透视时间（8.8 与 1028.7 秒，p<0.001）。
本研究证明了超声和输尿管镜辅助经皮肾镜取石术通道的可行性。该技术使透视时间减少了 99%以上。
