摘要
目的比较非血管超声造影与常规超声辅助经皮肾镜取石术(PCNL)治疗无明显积水(肾无积水或者轻度积水)肾结石的肾盏穹窿穿刺的准确率及安全性。方法本研究为前瞻性随机对照研究。2018年5月至2019年6月,按1∶1的比例将深圳市人民医院符合入组条件的无明显肾积水的肾结石患者,采用随机区组设计的方法分为非血管超声造影引导穿刺组(试验组)和常规超声引导穿刺组(对照组)。纳入标准:①年龄18~70岁;②符合肾结石诊断标准,目标肾盏无积水或轻度积水;③自愿受试并签署知情同意书。排除标准:①孕妇;②功能性孤立肾;③穿刺部位解剖异常或有损伤肠道风险;④有急性尿路感染;⑤有凝血功能障碍或正在服用影响凝血功能的药物;⑥有心力衰竭、严重心律失常等高危疾病;⑦肾功能异常(血清肌酐>1.2倍正常值上限);⑧严重肥胖(体质指数>40 kg/m^(2))。试验组经输尿管导管逆行注入超声造影剂六氟化硫微泡后行超声引导PCNL;对照组行传统超声引导PCNL。两组患者PCNL术后1周内经肾造瘘管顺行肾盂造影,判断是否经肾盏穹窿穿刺。记录血红蛋白下降值、穿刺时间、一次性穿刺成功率、住院时间、结石清除率,以及是否经肾盏穹窿穿刺的情况。结果本研究共纳入48例患者,试验组和对照组各24例。两组性别[男/女:19/5例与16/8例]、年龄[(44.2±11.2)岁与(45.4±10.7)岁]、体质指数[(21.8±2.8)kg/m^(2)与(21.81±2.7)kg/m^(2)]、结石长径[38.0(24.0,25.5)cm与35.5(24.8,47.0)cm]、结石位置[左/右:9/15例与9/15例]、肾积水情况[无/轻度:15/9例与16/8例]差异均无统计学意义(P>0.05)。试验组与对照组肾盏穹窿穿刺准确率[87.50%(21/24)与41.67%(10/24)]、血红蛋白下降值[2.0(0,12.0)g/L与14.0(7.0,17.0)g/L]、穿刺时间[40.0(28.5,53.0)s与70.0(55.5,84.5)s]、一次性穿刺成功率[95.83%(23/24)与75.00%(18/24)]差异均有统计学意义(P<0.05)。两组均未
Objective To compare the accuracy of renal calyceal fornix puncture and complication between non-vascular contrast-enhanced ultrasound(NV CEUS)and conventional ultrasound guided in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods This randomized controlled trial was conducted in nephrolithiasis patients with slight or no hydronephrosis in our hospital from May 2018 to June 2019.The patients were randomized to receive NV CEUS or conventional ultrasound guided PCNL.Inclusion criteria:age 18-70 years old and nephrolithiasis patients with slight or no hydronephrosis.Exclusion criteria:pregnant women,functional solitary kidney,abnormal anatomy or high-risk of intestinal injury,acute urinary tract infection,coagulation dysfunction or taking drugs that affect blood coagulation,heart failure,severe arrhythmia or other high-risk diseases,abnormal renal function(SCR>1.2-fold upper limit),or severe obesity(BMI>40 kg/m^(2)).Patients in both groups underwent anterorenal pyelography of renal fistula.Data of the study were recorded:the decrease in hemoglobin,the puncture time,the success rate of one needle puncture,the time of hospital stay,the stone for free,and postoperative renal fistula anterograde pyelography to confirm whether the puncture was performed through the calyces.Results A total of 48 patients were enrolled,24 patients in each group,the preoperative parameters were comparable between the two groups(all P>0.05).The puncture accuracy of calyces fornix in experimental group and control group was 87.50%(21/24)and 41.67%(10/24),respectively.The hemoglobin drop was 2.0(0.0,12.0)and 14.0(7.0,17.0)g/L,the puncture time was 40.0(28.5,53.0)and 70.0(55.5,84.5)seconds,and the success rate of one needle puncture was 95.83%(23/24)and 75%(18/24).The differences between the two groups were statistically significant(all P<0.05).No blood transfusion,interventional embolization,septic shock and other serious infection complications were found in the two groups.Conclusions For nephro
作者
刘增钦
赵楚标
肖克峰
Liu Zengqin;Zhao Chubiao;Xiao Kefeng(Department of Urology,Shenzhen People's Hospital,Jinan University Second Clinical Medical College,the First Affiliated Hospital of South University of Science and Technology,Shenzhen Urology Minimally Invasive Medical Engineering Technology Research and Development Center,Shenzhen 518020,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2021年第5期326-331,共6页
Chinese Journal of Urology
基金
广东省医学科学技术研究基金(B2020197)
2017年深圳市卫生系统科研项目(SZLY2017021)。
关键词
肾结石
经皮肾镜取石术
超声造影
Kidney calculi
Percutaneous nephrolithotomy
Ultrasonic contrast
