目的: 探讨在经皮肾镜碎石取石术(percutaneous nephrolithotomy,PCNL)中应用输尿管封堵器进行顺行反向封堵的临床价值。方法: 选择自2019年9月至2022年9月蚌埠医学院第一附属医院泌尿外科住院的肾结石患者60例,其中在行PCNL术中使用输尿管封堵器进行反向封堵的30例患者作为观察组,采用常规PCNL治疗的30例患者作为对照组,比较两组患者的手术出血量、手术时间、结石清除率、下移率和相关并发症发生率,并对疗效进行优、良、差分级综合性评估。结果: 观察组术中出血量(55.83±2.07)mL,与对照组出血量(55.73±2.02)mL差异无统计学意义(P＞0.05);观察组手术时间48.50(47.00~50.00)min和结石清除率(96.67%)高于对照组的手术时间46.00(45.00~48.00)min和结石清除率(80.00%)(P＜0.05);观察组结石下移率(3.33%)和相关并发症发生率(3.33%)低于对照组的下移率(23.33%)和并发症发生率(23.33%)(P＜0.05)。结论: 在PCNL术中应用输尿管封堵器进行顺行反向封堵,可有效促进结石清除和避免结石下移等不良事件发生。
Objective: To investigate the clinical value of ureteral occlusion apparatus for reverse blocking in percutaneous nephrolithotomy (PCNL). Methods: Sixty patients with renal calculi hospitalized in the Department of Urology, the First Affiliated Hospital of Bengbu Medical College from September 2019 to September 2022 were selected. Among them, 30 patients who used ureteral occlusion apparatus for reverse blocking during PCNL were used as the observation group, and 30 patients who were treated with conventional PCNL were used as the control group. The amount of bleeding, operation time, stone clearance rate, downward rate and incidence of related complications were compared between the two groups, and the efficacy was evaluated comprehensively by excellent, good and poor grades. Results: There was no significant difference in intraoperative bleeding volume between the observation group [(55.83±2.07)mL] and the control group [(55.73±2.02)mL] (P＞0.05). The operation time and stone clearance rate of the observation group were 48.50(47.00-50.00)min and 96.67%, which were higher than 46.00 (45.00-48.00) min and 80.00% of the control group (P＜0.05). The stone moving rate of the observation group was 3.33%, and the incidence of related complications was 3.33%, which were lower than 23.33% and 23.33% of the control group (P＜0.05). Conclusion: The application of ureteral occlusion apparatus in PCNL for reverse blocking can effectively promote stone clearance and avoid adverse events such as stone downward movement.
[1] 林方优,饶婷,程帆. 肾脏解剖在经皮肾镜碎石取石术通道建立中的临床应用进展[J]. 医学综述,2021,27(19):3864-3870.
[2] 黄静,李玉波,施奇珉,等. 尿路结石与中医体质的相关性及其研究进展[J]. 中医药临床杂志,2020,32(3):581-584.
[3] 张羽,白云金,唐寅,等. 经皮肾镜取石术不同入路对完全鹿角形肾结石疗效的影响[J]. 华西医学,2021,36(8):1068-1071.
[4] 吴紫扬,陈少锴,林宝东. 经皮肾镜碎石取石术后患者并发尿源性脓毒血症的危险因素分析[J]. 医学理论与实践,2022,35(5):803-805.
[5] 牛刚,马俊生,刘建军,等. 输尿管结石封堵器在治疗输尿管上段结石中的应用[J]. 新疆医学,2015,45(7):932-933.
[6] 余舟,张学齐,郭吉楠,等. 经皮肾镜碎石取石术中采用输尿管封堵器行反向封堵的临床观察[J]. 现代泌尿外科杂志,2019,24(5):361-364.
[7] 杨洋,钟一鸣,李珲,等. 输尿管封堵器在经皮肾镜手术中的应用[J]. 中华腔镜泌尿外科杂志(电子版),2016,10(3):169-172.
[8] 夏莺,李建路,裴莉,等. 2016-2019年飞行人员肾结石患病情况调查分析[J]. 空军医学杂志,2020,36(6):471-472,475.
[9] 张小军,张立国,高海洋,等. 输尿管软镜碎石术联合叶金排石胶囊治疗直径小于2 cm肾结石临床疗效分析[J]. 中华中医药学刊,2022,40(1):212-215.
[10] 张宝勋,蒋胜利,吴文弼,等. 经皮肾镜联合输尿管软镜治疗复杂肾结石[J]. 中国微创外科杂志,2021,21(10):875-878.
[11] 陈少川,张源锋. 两种经输尿管镜碎石术治疗输尿管结石的临床疗效比较[J]. 当代医学,2022,28(4):87-89.
[12] 罗学宏,高颜林. 经输尿管软镜碎石取石术与经皮肾镜碎石取石术治疗肾结石有效性和安全性观察 [J]. 贵州医药,2022,46(2):266-267.
[13] Kyriazis I, Panagopoulos V, Kallidonis P, et al. Complications in percutaneous nephrolithotomy [J]. World J Urol, 2015,33(8):1069-1077.
[14] 方少洪,廖国强,王勤军. 输尿管镜钬激光碎石术中安放输尿管封堵器治疗输尿管上段结石的效果分析[J]. 现代诊断与治疗,2019,30(22):4020-4022.
[15] Zeng GH, Cai C, Duan XZ, et al. Mini percutaneous nephrolithotomy is a noninferior modality to standard percutaneous nephrolithotomy for the management of 20-40mm renal calculi: a multicenter randomized controlled trial [J]. Eur Urol, 2021,79(1):114-121.
