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中华临床医师杂志(电子版)

中华临床医师杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 444 -447. doi: 10.3877/cma.j.issn.1674-0785.2020.06.009

所属专题： 文献；

临床研究

超声引导侧方穿刺和头端穿刺在经皮肾镜碎石术中应用的比较
周哲1, 晋连超1, 杨冰1, 潘东亮1, 贺利军1, 王义1, 李宁忱1,†()   
  1. 1. 100144　北京大学首钢医院泌尿外科
  • 收稿日期:2020-02-28 出版日期:2020-06-15
  • 通信作者: 李宁忱

Comparison of ultrasound-guided lateral puncture and head-end puncture in percutaneous nephrolithotripsy

Zhe Zhou1, Lianchao Jin1, Bing Yang1, Dongliang Pan1, Lijun He1, Yi Wang1, Ningchen Li1,†()   

  1. 1. Peking University Wujieping Urology Center, Peking University Shougang Hospital, Beijing 100144, China
  • Received:2020-02-28 Published:2020-06-15
  • Corresponding author: Ningchen Li
  • About author:
    Corresponding author: Li Ningchen, Email:
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周哲, 晋连超, 杨冰, 潘东亮, 贺利军, 王义, 李宁忱. 超声引导侧方穿刺和头端穿刺在经皮肾镜碎石术中应用的比较[J]. 中华临床医师杂志(电子版), 2020, 14(06): 444-447.

Zhe Zhou, Lianchao Jin, Bing Yang, Dongliang Pan, Lijun He, Yi Wang, Ningchen Li. Comparison of ultrasound-guided lateral puncture and head-end puncture in percutaneous nephrolithotripsy[J]. Chinese Journal of Clinicians(Electronic Edition), 2020, 14(06): 444-447.

目的

比较在经皮肾镜碎石术中超声引导侧方穿刺和头端穿刺的技术特点。

方法

回顾性分析2017年4月至2019年7月北京大学首钢医院就诊的肾中组后盏无积水完全或部分鹿角型肾结石行经皮肾镜手术治疗的30例患者的临床资料，采用侧方穿刺和头端穿刺技术穿刺肾中组后盏的患者各15例。采用t检验比较2组患者在寻找穿刺盏拟定穿刺路径时间、穿刺成功时间、穿刺成功所需次数的差异，并观察2组患者有无严重并发症发生。

结果

在寻找穿刺盏拟定穿刺路径的时间方面，侧方穿刺组所需的时间比头端穿刺组短［（37.82±8.94）s vs（51.83±13.16）s］；而在穿刺成功的时间方面，侧方穿刺组所需的时间比头端穿刺组长［（51.36±24.10）s vs（29.20±12.35）s］，差异均具有统计学意义（t=2.712、4.122，P=0.019、0.001）。在穿刺成功所需次数方面，侧方穿刺组和头端穿刺组分别为（2.13±0.74）次和（1.73±0.70）次，差异无统计学意义（t=1.382，P=0.189）。2组患者均未出现重要脏器损伤和术后大出血。

结论

在经皮肾镜超声定位穿刺操作中，侧方穿刺和头端穿刺技术各有优缺点；无论掌握哪一种穿刺技术，都可以做到精准穿刺。

关键词: 经皮肾镜碎石术, 侧方穿刺, 头端穿刺
Objective

To compare the technical features of ultrasound-guided lateral puncture and head-end puncture in percutaneous nephrolithotripsy.

Methods

A retrospective analysis was performed on 30 patients with complete or partial staghorn calculi but without hydronephrosis in the middle-back calyces who were treated by percutaneous nephrolithotripsy at Peking University Shougang Hospital from April 2017 to July 2019. They were divided into a lateral puncture group (15 cases) and a head-end puncture group (15 cases). The t-test was used to compare the time of finding the puncture route, the successful puncture time, and the number of times of puncture between the two groups. Serious complications were also recorded.

Results

There was a statistically significant difference between the lateral puncture group and the head-end puncture group in the time of finding the puncture route [(37.82±8.94) s vs (51.83±13.16) s, t=2.712, P=0.019] and the successful puncture time (51.36±24.10) s vs (29.20±12.35) s, t=4.122, P=0.001). There was no statistically significant difference in the number of times of puncture [(2.13±0.74) vs (1.73±0.70), t=1.382, P=0.189]. There was no significant organ injury or postoperative hemorrhage in either group.

Conclusion

The lateral puncture and head-end puncture have their own advantages in ultrasound-guided percutaneous nephrolithotripsy. No matter which puncture technique is mastered, accurate puncture can be achieved.

Key words: Percutaneous nephrolithotripsy, Lateral puncture, Head-end puncture
表1 2组经皮肾镜碎石取石术患者基线资料比较
组别 例数 男/女（例） 年龄（岁，±s） 体质量指数（kg/m2，±s） 拟穿刺肾盏到皮肤的距离（cm，±s） 拟穿刺肾盏宽度（cm，±s） 人工肾积水后可见肾积水例数［例（%）］
侧方穿刺组 15 6/9 45.40±5.90 24.35±3.65 6.01±0.92 0.67±0.12 12（80.0）
头端穿刺组 15 7/8 44.47±4.41 24.67±4.04 6.43±0.61 0.70±0.09 13（86.7）
统计值 ? χ2=0.136 t=0.879 t=0.290 t=1.749 t=0.837 0.240
P值 ? 0.713 0.394 0.776 0.102 0.417 0.624
表2 2组经皮肾镜碎石取石术患者术中资料比较（±s）
指标 例数 寻找穿刺盏拟定穿刺路径时间（s） 穿刺成功时间（s） 穿刺成功所需次数（次）
侧方穿刺组 15 37.82±8.94 51.36±24.10 2.13±0.74
头端穿刺组 15 51.83±13.16 29.20±12.35 1.73±0.70
t值 ? 2.712 4.122 1.382
P值 ? 0.019 0.001 0.189
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