[完全超声引导下经皮肾镜取石术：一种高效且安全的技术]
[Totally ultrasound guided percutaneous nephrolithotomy: An efficient and safe technique].
作者信息
Gutiérrez-Tapia David, García-Padilla Miguel Ángel, Ríos-Melgarejo Carlos, Medrano-Sánchez Javier, Pulido-Contreras Enrique
机构信息
Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, Servicio de Urología. León, Guanajuato, México.
Instituto Mexicano del Seguro Social, Centro Médico Nacional del Bajío, Hospital de Especialidades No. 1, División de Educación en Salud. León, Guanajuato, México.
出版信息
Rev Med Inst Mex Seguro Soc. 2025 Aug 14;63(5):e6701. doi: 10.5281/zenodo.16748335.
BACKGROUND
Percutaneous nephrolithotomy (PCNL) is the treatment for large and complex renal stones. Fluoroscopic guidance is the most used imaging method; however, radiation exposure is a significant concern. Recent studies have shown that ultrasound-guided PCNL is also feasible.
OBJECTIVE
To evaluate the safety of the two-step tract dilation technique using ultrasound guidance to avoid radiation exposure.
MATERIAL AND METHODS
Retrospective evaluation of data of patients treated between February 2019 and January 2023. Two groups were included based on tract dilation: Group 1 (G1): two-step totally ultrasound-guided dilation, and group 2 (G2): fluoroscopy-guided dilation.
RESULTS
100 patients were included, 50 in each group. Body mass index (31.7 vs. 28.7kg/m²; p = 0.002) and stone burden (10,935.69 vs. 5,460.86mm³; p = 0.006) were higher in G1; fluoroscopy was absent in the same group (0 vs. 29.4 sec; p < 0.005). Complications occurred in 13 patients in G1 and in 7 in G2 (p = 0.32); no complications grade 3b, 4 or 5 were observed in either group. The overall stone-free rate was 76% (74% vs. 78%; p = 0.81).
CONCLUSIONS
Ultrasound-guided PCNL is a safe technique that avoids radiation exposure without compromising clinical outcomes.
背景
经皮肾镜取石术（PCNL）是治疗大型复杂肾结石的方法。荧光透视引导是最常用的成像方法；然而，辐射暴露是一个重大问题。最近的研究表明，超声引导下的PCNL也是可行的。
目的
评估使用超声引导避免辐射暴露的两步通道扩张技术的安全性。
材料与方法
回顾性评估2019年2月至2023年1月期间接受治疗的患者数据。根据通道扩张情况分为两组：第1组（G1）：完全超声引导下的两步扩张，第2组（G2）：荧光透视引导下的扩张。
结果
共纳入100例患者，每组50例。G1组的体重指数（31.7 vs. 28.7kg/m²；p = 0.002）和结石负荷（10,935.69 vs. 5,460.86mm³；p = 0.006）更高；该组无荧光透视（0 vs. 29.4秒；p < 0.005）。G1组有13例患者发生并发症，G2组有7例（p = 0.32）；两组均未观察到3b、4或5级并发症。总体无结石率为76%（74% vs. 78%；p = 0.81）。
结论
超声引导下的PCNL是一种安全的技术，可避免辐射暴露且不影响临床结果。
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