微创医学

目的探讨导丝硬头引导的经皮肾通道扩张法在经皮肾镜碎石术（PCNL）中应用的安全性及有效性。方法回顾性分析119例完成PCNL的肾及上段输尿管结石患者的临床资料，将采用导丝硬头引导的经皮肾通道扩张法建立经皮肾通道的52例患者作为A组，采用导丝软头引导的通道扩张法建立经皮肾通道的67 例患者作为B组。比较两组患者的年龄、性别、BMI、既往手术史、肾积水程度及S.T.O.N.E.评分等术前基本资料，以及一次建立通道成功率、中转开放手术情况、建立通道时间、通道严重出血发生率、术后血红蛋白（Hb）较术前下降值、死亡及患肾切除情况、其他通道相关并发症发生情况等术中及术后观察指标。结果两组术前基本资料的差异均无统计学意义（均P＞0.05）。两组均无中转开放或二期开放手术探查，无死亡及患肾切除病例。A组一次建立通道成功率高于B组，建立通道时间短于B组，术后Hb较术前下降值低于B组（均P＜0.05）；两组通道严重出血率及其他通道相关并发症发生率差异均无统计学意义（均P＞0.05）。结论导丝硬头引导的经皮肾通道扩张法在PCNL中应用的安全性及有效性较高，可提高一次建立通道成功率，缩短建立通道时间，减少术中出血量，值得临床推广应用。

ObjectiveTo investigate the safety and effectiveness of percutaneous renal passage dilatation guided by guidewire hard tip in percutaneous nephrolithotomy (PCNL). MethodsA retrospective study was conducted on clinical data of 119 patients of renal and upper ureteral calculus who underwent PCNL. A total of 52 patients who underwent percutaneous renal passage dilatation guided by guidewire hard tip were selected as group A, and 67 patients who underwent percutaneous renal passage dilatation guided by guidewire soft tip were selected as group B. Preoperative basic data such as age, gender, body mass index (BMI), history of previous surgery, degree of hydronephrosis, and S.T.O.N.E. score were compared between the two groups, as well as the intraoperative and postoperative observation indexes such as the success rate of one-time channel establishment, the situation of conversion to open surgery, the time of channel establishment, the incidence of severe channel bleeding, the decrease value of postoperative hemoglobin (Hb) compared with that before operation, death and nephrectomy, and other channel-related complications. ResultsThere was no statistically significant difference in preoperative basic data between the two groups (all P＞0.05). There was no conversion to open or second-stage open surgical exploration, no death or nephrectomy in the two groups. The success rate of one-time channel establishment in group A was higher than that in group B, the time of channel establishment was shorter than that in group B, and the decrease value of postoperative Hb compared with that before operation was lower than that in group B (all P＜0.05). There was no statistically significant difference in the rate of severe channel bleeding and the incidence of other channel-related complications between the two groups (all P＞0.05). ConclusionPercutaneous renal passage dilatation guided by guidewire hard tip in PCNL is safe and effective, which can improve the success rate of one-time channel establishment, shorten the time of channel establishment and reduce the amount of intraoperative blood loss, and is worthy of clinical application.