Xiong Jing, Shi Ying, Zhang Xiaoping, Xing Yifei, Li Wencheng
Department of Nephrology, Union Hospital, Tongji Medical College, Huangzhong University of Science and Technology, Wuhan, China.
Department of Urology, Union Hospital, Tongji Medical College, Huangzhong University of Science and Technology, Wuhan, China.
Urol J. 2019 Feb 21;16(1):21-26. doi: 10.22037/uj.v16i1.4610.
Nephrostomy tract creation is a key step to perform a successful percutaneous nephrolithotomy (PCNL). In an attempt to improve the conventional technique of the tract dilation, a Chinese one-shot dilation was developed and compared with the sequential fascial dilation.
We retrospectively reviewed medical records of 116 patients who had undergone 116 PCNL in our department from January 2012 to December 2012. The nephrostomy tracts had been created by using Chinese one-shot (one-shot group, 59 cases) or sequential fascial dilation technique (sequential group, 57 cases). Tract creation time, hemorrhage loss, overall renal function, tract dilation failure and major complications were compared between the two groups.
The one-shot group had a significantly shorter mean (SD) tract creation time (1.9±0.4 vs 4.6±0.9 min, P<0.001) and lower mean (SD) decrease in hemoglobin concentration (0.59±0.32 vs 0.68±0.37 g/dL, P=0.0009) compared to the sequential group, respectively. There were no significant differences in mean (SD) value changes of pre- and post-operative serum creatine concentrations (4.6±11.3 vs 4.9±14.7 ?mol/L, P=0.259) between the one-shot and sequential group. No tract dilation failure or major complications occurred in both of the groups.
This study demonstrated that the Chinese one-shot dilation technique is as safe and feasible as the conventional sequential fascial dilation. Furthermore, a greater reduction in tract creation time and blood loss was achieved using this technique.
建立肾造瘘通道是成功实施经皮肾镜取石术（PCNL）的关键步骤。为改进传统的通道扩张技术，研发了一种中国式一次性扩张方法，并与序贯筋膜扩张法进行比较。
我们回顾性分析了2012年1月至2012年12月在我科接受116例PCNL手术的116例患者的病历。肾造瘘通道采用中国式一次性扩张法（一次性扩张组，59例）或序贯筋膜扩张技术（序贯扩张组，57例）建立。比较两组的通道建立时间、失血量、总体肾功能、通道扩张失败情况及主要并发症。
与序贯扩张组相比，一次性扩张组的平均（标准差）通道建立时间显著缩短（1.9±0.4 vs 4.6±0.9分钟，P<0.001），血红蛋白浓度的平均（标准差）下降幅度更低（0.59±0.32 vs 0.68±0.37 g/dL，P=0.0009）。一次性扩张组与序贯扩张组术前和术后血清肌酐浓度的平均（标准差）值变化无显著差异（4.6±11.3 vs 4.9±14.7 μmol/L，P=0.259）。两组均未发生通道扩张失败或严重并发症。
本研究表明，中国式一次性扩张技术与传统的序贯筋膜扩张技术一样安全可行。此外，使用该技术可使通道建立时间和失血量有更大程度的减少。
