Pulido-Contreras Enrique, Garcia-Padilla Miguel Angel, Medrano-Sanchez Javier, Leon-Verdin Guadalupe, Primo-Rivera Miguel Angel, Sur Roger L
Urology Department, Unidad Medica de Alta Especialidad No. 1 Bajio, Instituto Mexicano del Seguro Social (IMSS), Lopez Mateos S/N., 37320, Leon, Guanajuato, Mexico.
Delegación del Instituto Mexicano del Seguro Social (IMSS), Coordinación de Planeación y Enlace Institucional, Leon, Guanajuato, Mexico.
World J Urol. 2021 Sep;39(9):3579-3585. doi: 10.1007/s00345-021-03636-2. Epub 2021 Mar 1.
The ultrasound-guided (US) puncture in percutaneous nephrolithotomy (PCNL) has demonstrated advantages over traditional fluoroscopy access. The aim of this study was to demonstrate the reduction of fluoroscopy time using this technique during PCNL as the surgeon gained experience.
Transversal study performed on 30 consecutive patients undergoing PCNL from March to November 2019. All punctures were performed with US guidance. The patients were divided into 2 groups of 15 each according to the chronological order of the intervention. Demographic data, preoperative parameters, puncture time, fluoroscopy time, stone-free rate and complications were analyzed.
The time of fluoroscopy was considerably reduced as the experience in the number of cases increased, reducing from 83.09 ± 47.8 s in group 1 to 22.8 ± 10.3 s in group 2 (p < 0.01), the time required to perform the puncture was reduced of 108.1 ± 68.9 s in group 1, to 92.6 ± 94.7 s in group 2 (p < 0.67). Stone free rate of 83.3% was obtained globally.
US percutaneous renal access is safe and reproducible technique; the main advantage is to reduce exposure to radiation without compromising clinical results and has a short learning curve for urologists with prior experience in PCNL.
经皮肾镜取石术（PCNL）中超声引导（US）穿刺已显示出优于传统透视引导穿刺的优势。本研究的目的是证明在PCNL手术过程中，随着外科医生经验的增加，使用该技术可减少透视时间。
对2019年3月至11月连续30例行PCNL的患者进行横向研究。所有穿刺均在超声引导下进行。根据干预的时间顺序将患者分为两组，每组15例。分析人口统计学数据、术前参数、穿刺时间、透视时间、结石清除率和并发症。
随着病例数量经验的增加，透视时间显著减少，从第1组的83.09±47.8秒降至第2组的22.8±10.3秒（p<0.01），穿刺所需时间从第1组的108.1±68.9秒降至第2组的92.6±94.7秒（p<0.67）。总体结石清除率为83.3%。
超声引导下经皮肾穿刺是一种安全且可重复的技术；其主要优点是减少辐射暴露，同时不影响临床效果，对于有PCNL经验的泌尿外科医生来说学习曲线较短。
