Department of Urology, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China.
Division of Urology, Department of Surgery, University of Maryland School of Medicine, Baltimore, USA.
World J Urol. 2020 Jun;38(6):1569-1576. doi: 10.1007/s00345-019-02876-7. Epub 2019 Jul 16.
To investigate the feasibility and safety of tract dilation monitored by ultrasound in percutaneous nephrolithotomy (PCNL) and identify suitable patients for this technique.
Patients who underwent PCNL with only one access (24 Fr) using the balloon dilator or sequential dilators (Amplatz and telescopic metal dilators) from December 2014 to May 2018 in Beijing Tsinghua Changgung Hospital were retrospectively reviewed. Patients' demographic information, intra- and postoperative data were analyzed. Factors which would increase the success rate of ultrasound-guided balloon dilation were investigated by logistic regression analysis.
There were 986 PCNLs performed. 207 cases underwent balloon dilation, while 411 underwent sequential dilation. The two groups did not significantly differ in age, sex, BMI, stone diameter, access location, operation time, postoperative complication rate, and stone-free rate. The balloon dilation group comprised 207 patients (115 males, 92 females) with a mean age of 51 ± 10 years. Mean BMI was 25.2 ± 3.3 kg/m. Mean stone size was 3.6 ± 1.2 cm, 47.3% of which were staghorn stones. Hydronephrosis of the targeted calyx occurred in 78.3% of patients. Within the balloon dilation group, tract dilation failed in 24 cases (11.6%) on the first attempt. The successful and failed subgroups had comparable outcomes. Multivariate analysis revealed that the risk factors for the failure of access establishment were the presence of staghorn stones (p = 0.032), prior ipsilateral open nephrolithotomy (p = 0.026), and lower pole access (p = 0.039), while the success rate was significantly higher in those with a hydronephrotic target calyx (p = 0.001).
Tract dilation using balloon catheter can be safely monitored by ultrasound, and is most suited to patients with a hydronephrotic target calyx.
探讨超声引导经皮肾镜取石术（PCNL）中通道扩张的可行性和安全性，并确定适合该技术的患者。
回顾性分析 2014 年 12 月至 2018 年 5 月在北京清华长庚医院行 PCNL 治疗，仅使用 24Fr 球囊扩张器或顺行扩张器（Amplatz 和可伸缩金属扩张器）行单通道（24Fr）的患者。分析患者的人口统计学信息、围手术期资料。采用 logistic 回归分析探讨影响超声引导下球囊扩张成功率的因素。
共进行了 986 例 PCNL 手术。207 例患者接受了球囊扩张，411 例患者接受了顺行扩张。两组患者在年龄、性别、BMI、结石直径、通道位置、手术时间、术后并发症发生率和结石清除率方面无显著差异。球囊扩张组 207 例患者（115 例男性，92 例女性），平均年龄 51±10 岁，平均 BMI 为 25.2±3.3kg/m2，平均结石大小为 3.6±1.2cm，其中 47.3%为鹿角形结石。目标肾盏存在积水的患者占 78.3%。在球囊扩张组中，首次尝试时通道扩张失败的有 24 例（11.6%）。成功组和失败组的结果无显著差异。多因素分析显示，通道建立失败的危险因素包括鹿角形结石（p=0.032）、同侧既往开放取石术（p=0.026）和下极通道（p=0.039），而目标肾盏积水的患者成功率显著更高（p=0.001）。
球囊导管经超声引导扩张通道是安全可行的，最适合目标肾盏积水的患者。
