Su Boxing, Song Haifeng, Yang Zesong, Yang Wenzeng, An Feng, Chen Fangzhi, He Peng, Li Gonghui, Wu Haiyang, Yang Jinjian, Li Songchao, Liu Yubao, Bai Wenjie, Wang Shu, Xiao Bo, Hu Weiguo, Li Jianxing
Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No.168 Litang Road, Dongxiaokou Town, Changping District, Beijing, China.
Department of Urology, Fujian Provincial Hospital, Fuzhou, Fujian, China.
World J Urol. 2022 Sep;40(9):2339-2345. doi: 10.1007/s00345-022-04072-6. Epub 2022 Jul 11.
To investigate the safety and efficacy of ultrasound-guided renal access and tract dilation using balloon dilators, as well as to identify suitable patients for this technique.
Consecutive patients undergoing ultrasound-guided PCNL using balloon dilators between December 2019 and June 2020 in seven large medical centers from China were prospectively enrolled. Demographic and perioperative parameters of the patients were collected. Logistic regression analysis was used to analyze factors that would affect the success rate of tract establishment using ultrasound-guided renal access and balloon dilation.
A total of 170 patients were included in this study, among whom, 91.18% of the (155/170) patients had a successful tract establishment under ultrasound guidance on the first attempt. The stone-free rate was 83.5% and postoperative complications occurred in 14 patients (8.23%). In univariate analysis, history of ipsilateral surgery (p = 0.026), and stone diameter (p = 0.01) were significantly associated with tract establishment failure, while a larger width of the target calyx (p = 0.016) and the presence of hydronephrosis (p = 0.001) were significantly associated with a successful tract establishment. In multivariate analysis, only hydronephrosis in target calyx (p = 0.027) was a favorable factor for successful tract establishment, and the history of ipsilateral renal surgery (p = 0.012) was the only independent risk factor for failure of tract establishment.
It was safe and effective to establish percutaneous renal access with balloon dilation under whole-process ultrasound monitoring during PCNL. Furthermore, patients with a hydronephrotic target calyx and without history of ipsilateral renal surgery were most suited to this technique. Trial registration CHiCTR1800014448.
探讨超声引导下使用球囊扩张器进行肾穿刺通道建立及通道扩张的安全性和有效性，并确定适合该技术的患者。
前瞻性纳入2019年12月至2020年6月在中国7家大型医疗中心接受超声引导下使用球囊扩张器进行经皮肾镜取石术（PCNL）的连续患者。收集患者的人口统计学和围手术期参数。采用逻辑回归分析影响超声引导下肾穿刺通道建立及球囊扩张成功率的因素。
本研究共纳入170例患者，其中91.18%（155/170）的患者在超声引导下首次尝试成功建立通道。结石清除率为83.5%，14例患者（8.23%）发生术后并发症。单因素分析中，同侧手术史（p = 0.026）和结石直径（p = 0.01）与通道建立失败显著相关，而目标肾盏较宽（p = 0.016）和存在肾积水（p = 0.001）与通道建立成功显著相关。多因素分析中，仅目标肾盏存在肾积水（p = 0.027）是通道建立成功的有利因素，同侧肾脏手术史（p = 0.012）是通道建立失败的唯一独立危险因素。
在PCNL过程中，全程超声监测下使用球囊扩张建立经皮肾穿刺通道是安全有效的。此外，目标肾盏有肾积水且无同侧肾脏手术史的患者最适合该技术。试验注册号：CHiCTR1800014448。
