Wang Yiwei, Gao Liheng, Xu Mingxi, Li Wenfeng, Mao Yuanshen, Wang Fujun, Wang Lu, Da Jun, Wang Zhong
Department of Urology, Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Key Laboratory of Textile Science and Technology, Ministry of Education, College of Textiles, Donghua University, Shanghai, China.
Asian J Urol. 2021 Oct;8(4):424-429. doi: 10.1016/j.ajur.2021.04.001. Epub 2021 Apr 15.
In second-stage percutaneous nephrolithotomy (PCNL), because the hydronephrosis has been decompressed, the dilated renal pelvis has resolved and the space is small. Consequently, introduction of the tip of the Amplatz dilator can cause injury to the opposite side of the renal-pelvic mucosa. In this study, we report the experimental and initial clinical performance of a spherical-headed fascial dilator developed specifically for second-stage PCNL.
The novel spherical-headed dilator was compared with existing tapered-headed dilators in configuration and in puncture resistance utilizing a static puncture test. Subsequently, a pilot clinical study was conducted during which patients scheduled to undergo second-stage PCNL from June 2019 to October 2019 in our center were enrolled. A typical ultrasound guided PCNL procedure was performed with the exception that the new spherical-headed fascial dilator was substituted for a tapered-headed one.
Experimentally, stab resistance against polyethylene film was significantly increased using the novel spherical-headed dilator compared to the traditional tapered-headed dilators (<0.005). In the clinical study, the novel dilators were successfully introduced into the renal pelvis and passed down the collecting system in all eight second-stage PCNL cases. There were no cases of renal pelvic perforation or brisk hemorrhage nor need for transfusion.
The design of the novel spherical-headed fascial dilator avoided the concentration of pressure at the tapered tip of the current Amplatz dilator by increasing the contact area and uniformly distributing and diffusing the pressure. Therefore, it is feasible to use the spherical-headed fascial dilator for second-stage PCNL.
在二期经皮肾镜取石术（PCNL）中，由于肾积水已得到减压，扩张的肾盂已恢复，空间变小。因此，插入安普瑞兹扩张器尖端可能会损伤肾盂黏膜的对侧。在本研究中，我们报告了专门为二期PCNL开发的球形头筋膜扩张器的实验和初步临床性能。
通过静态穿刺试验，将新型球形头扩张器与现有的锥形头扩张器在结构和抗穿刺性方面进行比较。随后，进行了一项初步临床研究，纳入了2019年6月至2019年10月在我们中心计划接受二期PCNL的患者。除了用新型球形头筋膜扩张器替代锥形头扩张器外，进行了典型的超声引导PCNL手术。
在实验中，与传统的锥形头扩张器相比，使用新型球形头扩张器对聚乙烯薄膜的抗穿刺性显著提高（<0.005）。在临床研究中，在所有8例二期PCNL病例中，新型扩张器均成功插入肾盂并通过集合系统。没有肾盂穿孔或大出血病例，也无需输血。
新型球形头筋膜扩张器的设计通过增加接触面积并均匀分布和分散压力，避免了当前安普瑞兹扩张器锥形尖端的压力集中。因此，将球形头筋膜扩张器用于二期PCNL是可行的。
