摘要
目的探讨在无管化经皮肾镜取石术(PCNL)中运用双极等离子电切袢对肾造瘘通道进行主动止血的安全性及有效性。方法回顾性选取2020年7月至2021年9月福建医科大学附属协和医院泌尿外科收治的107例行无管化PCNL的患者作为研究对象。所有患者均B超引导下经皮肾穿刺扩张建立F20号经皮肾通道,采用超声碎石,清石结束后留置双J管,不放肾造瘘管。按照碎石结束后是否对经皮肾通道进行主动止血分为通道无止血组(76例)和通道主动止血组(31例)。通道无止血组患者在碎石结束后缓慢退镜观察通道无明显出血后拔除剥皮鞘,按压切口1 min后直接缝闭切口。通道主动止血组患者碎石结束后采用双极等离子电切袢联合输尿管镜自制止血设备,在退镜过程中行通道主动止血后拔除剥皮鞘缝闭切口。比较两组患者的一般资料、结石部位及负荷量、手术时间、术后血红蛋白(Hb)下降值、术后发热率、术后血尿严重程度、术后清石率、术后并发症发生率等指标。结果107例患者手术均顺利完成,无中转开放和肾动脉栓塞病例,无周围脏器损伤及感染性休克病例发生,1例患者出院后1周因血尿再次入院,行输血等保守治疗后好转。所有病例发热发生率为2.8%(3/107),术后输血率0.9%(1/107),术后住院时间为1~2 d。术后1 d,通道主动止血组血尿严重程度低于通道无止血组,差异有统计学意义(P<0.05);两组患者手术时间、术后住院天数、术后Hb下降值、术后清石率、术后发热率和输血率比较,差异均无统计学意义(P>0.05)。术后复查腹部平片,101例患者无结石残留或无临床意义残留结石,6例患者结石残留或结石位于平行盏,术后2例患者行体外震波碎石,4例患者行输尿管软镜碎石。107例患者随访3~6个月,无结石复发及其他并发症发生。结论采用双极等离子电切袢用于无管化经皮肾通道的主动止血技术降低了术后出血及血尿的风险,促进患者快速康复。
Objective To investigate the safety and effectiveness of bipolar plasma loop on hemostasis of nephrostomy channel in tubeless percutaneous nephrolithotomy(PCNL).Methods A total of 107 patients undergoing tubeless PCNL admitted to the Department of Urology,Fujian Medical University Union Hospital from July 2020 to September 2021 were retrospectively selected as the research subjects.All patients underwent percutaneous renal puncture and expansion under the guidance of B-ultrasound to establish F20 percutaneous renal channel.Ultrasonic lithotripsy was used.After stone cleaning,double J tubes were retained without nephrostomy.According to whether active hemostasis was performed on the percutaneous renal channel after lithotripsy,the patients were divided into the non-channel hemostasis group(76 cases)and active channel hemostasis group(31 cases).In the non-channel hemostasis group,after the lithotripsy was completed,the microscope was slowly withdrawn to observe that there was no obvious bleeding in the channel,the peeling sheath was removed,and the incision was directly sutured after pressing the incision for 1 min.In the active channel hemostasis group,after lithotripsy,bipolar plasma electric resection loop combined with ureteroscope self-made hemostatic device was used to perform active channel hemostasis during the retraction process,then the peeling sheath was removed and the incision was closed.The general data of the two groups of patients were compared,such as stone location and load,operation time,postoperative hemoglobin(Hb)decline,postoperative fever rate,postoperative hematuria severity,stone removal rate,postoperative complication rate and other indicators.Results All of 107 patients completed the operation successfully,and there were no cases of conversion to open or renal artery embolism,and no cases of peripheral organ damage and septic shock.One patient was readmitted due to hematuria 1 week after discharge,and improved after conservative treatment such as blood transfusion.The incidence of fever in all cases was 2.8%(3/107),the postoperative blood transfusion rate was 0.9%(1/107),and the postoperative hospital stay was 1 to 2 d.One day after operation,the severity of hematuria in the active channel hemostasis group was less than that in the non-channel hemostasis group,and the difference was statistically significant(P<0.05).There were no significant differences between the two groups in operation time,postoperative hospital stay,postoperative Hb decline,postoperative stone removal rate,postoperative fever rate and blood transfusion rate(P>0.05).Plain abdominal film reexamination showed that 101 cases had no residual stones or no clinically significant residual stones,6 cases had residual stones or stones located in parallel calices,2 cases underwent extracorporeal shock wave lithotripsy and 4 cases underwent ureteroscopic lithotripsy.All of 107 cases were followed up for 3-6 months.There were no complications and no recurrence of kidney and ureteral stones.Conclusion The active hemostasis technology of bipolar plasma loop for tubeless PCNL can further reduce the risk of postoperative bleeding and hematuria and promote the rapid recovery of patients.
作者
杨旭
周凯
李永生
YANG Xu;ZHOU Kai;LI Yongsheng(Department of Urology,Fujian Medical University Union Hospital,Fujian Province,Fuzhou350001,China)
出处
《中国当代医药》
CAS
2022年第34期130-134,共5页
China Modern Medicine
基金
福建省卫生健康委科技计划项目(2021QNA012)。
关键词
无管化
经皮肾镜
通道止血
双极等离子
Tubeless
Percutaneous nephroscopy
Channel hemostasis
Bipolar plasma
