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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) ›› 2025, Vol. 19 ›› Issue (12) : 886 -891. doi: 10.3877/cma.j.issn.1674-0785.2025.12.002

临床研究

超声引导全程可视化建立经皮肾通道对低年资医师经皮肾镜取石术的效果初探
张际青1,3,†(), 王欣2, 唐伟3, 刘桂迁3, 张家兴3, 雷晔1, 赵佳晖1, 洪保安1, 薄予轩1, 张宁1   
  1. 1　101100　北京，首都医科大学附属北京安贞医院泌尿外科
    2　056200　河北武安，河北省武安市第一人民医院泌尿外科
    3　065201　河北廊坊，河北燕达医院泌尿外科
  • 收稿日期:2025-11-16 出版日期:2025-12-30
  • 通信作者: 张际青
  • 基金资助:
    2022年廊坊市科学技术研究与发展计划自筹经费项目(2022013007)

Ultrasound-guided total visual access establishment for percutaneous nephrolithotomy skill acquisition by junior surgeons: a preliminary study

Jiqing Zhang1,3,†(), Xin Wang2, Wei Tang3, Guiqian Liu3, Jiaxing Zhang3, Ye Lei1, Jiahui Zhao1, Baoan Hong1, Yuxuan Bo1, Ning Zhang1   

  1. 1 Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Beijing 101100, China
    2 Department of Urology, the First People's Hospital of Wu'an City, Wu'an 056200, China
    3 Department of Urology, Hebei Yanda Hospital, Langfang 065201, China
  • Received:2025-11-16 Published:2025-12-30
  • Corresponding author: Jiqing Zhang
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张际青, 王欣, 唐伟, 刘桂迁, 张家兴, 雷晔, 赵佳晖, 洪保安, 薄予轩, 张宁. 超声引导全程可视化建立经皮肾通道对低年资医师经皮肾镜取石术的效果初探[J/OL]. 中华临床医师杂志(电子版), 2025, 19(12): 886-891.

Jiqing Zhang, Xin Wang, Wei Tang, Guiqian Liu, Jiaxing Zhang, Ye Lei, Jiahui Zhao, Baoan Hong, Yuxuan Bo, Ning Zhang. Ultrasound-guided total visual access establishment for percutaneous nephrolithotomy skill acquisition by junior surgeons: a preliminary study[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2025, 19(12): 886-891.

目的

探讨采用超声引导全程可视化建立皮肾通道对年轻医师行经皮肾镜取石术（PCNL）效果的影响，建立一种新的PCNL辅助学习方法。

方法

回顾性分析2022年1月~2024年12月10名低年资医师分别用传统方法建立经皮肾通道（CAE组）和全程可视下建立经皮肾通道（VAE组）行PCNL的手术结果。从建立通道成功率、建立通道时间、手术时间、术后血红蛋白下降和术后1月手术成功率等方面评价全程可视下建立经皮肾通道对年轻医师行PCNL的影响。

结果

纳入190例患者。CAE组100例，建立通道成功率为82%（82/100例），低于VAE组的93.3%（84/90）（P＜0.05），2组建立通道失败者均予以排除。CAE组建立通道的时间明显长于VAE组（7.2±1.4 min vs 4.9±1.0 min）（P＜0.05）。CAE组的内镜手术时间明显长于VAE组（60.6±56.8 min vs 43.2± 10.0 min）（P＜0.05）。CAE组术后第1 d血红蛋白下降明显高于VAE组（13.1±4.5 g/L vs 9.1±1.4 g/L）（P＜0.05）。CAE组Ⅲ/Ⅳ级并发症明显高于VAE组［6.1%（5/82）vs 0%（0/90）（P＜0.05）］。CAE组术后1月手术成功率明显低于VAE组［73.2%（60/82）vs 86.9%（73/84）］。

结论

超声引导全程可视下建立经皮肾通道能够提高低年资医师的手术成功率和安全性，可作为初学者的一种辅助手术方法。

关键词: 肾结石, 经皮肾镜取石术, 学习曲线, 可视穿刺, 可视球囊扩张
Objective

To investigate the role of ultrasound-guided total visual access establishment for percutaneous nephrolithotomy (PCNL) skill acquisition by junior surgeons and to establish a novel auxiliary learning method for PCNL.

Methods

A retrospective analysis was conducted on the surgical outcomes of PCNL performed by 10 novice urologists using ultrasound-guided conventional access establishment (CAE) and total visual access establishment (VAE) from January 2022 to December 2024, respectively. Items related to PCNL learning such as access establishment success, access establishment time, operation time, hemoglobin decrease, surgery success rate at 1 month postoperatively was evaluated.

Results

One hundred and ninety cases were included. In the CAE group (100 cases), 18 cases failed to establish percutaneous renal access, while 6 failed in the VAE group (90 cases). The 24 cases with failed access establishment in both groups were excluded. The access establishment success rate in the CAE group was significantly lower than that of the VAE group [82% (82/100) vs 93.3% (84/90); P＜0.05]. Access establishment time in the CAE group was significantly longer than that of the VAE group (7.2±1.4 min vs 4.9±1.0 min, P＜0.05). Operation time in the CAE group was significantly longer than that of the VAE group (60.6±56.8 min vs 43.2±10.0 min, P＜0.05). Hemoglobin decrease on the first day after surgery in the CAE group was significantly higher than that of the VAE group (13.1±4.5 g/L vs 9.1±1.4 g/L, P＜0.05). The rate of postoperative Clavien-Dindo Ⅲ/Ⅳ complications in the CAE group was significantly higher than that of the VAE group [6.1% (5/82) vs 0% (0/90), P＜0.05].

Conclusion

Ultrasound-guided total visual access establishment may improve PCNL success rate and safety for novice urologists, establishing a promising new learning aid for beginners.

Key words: Kidney stones, Percutaneous nephrolithotrips, Learning curving, Visual puncture, Visual balloon dilation
图1 病例筛选流程图。CAE为传统通道建立；VAE为全程可视通道建立
表1 患者一般资料和结石情况
CAE VAE P值
年龄（岁，
±s）		 53.7±12.5 54.3±9.0 0.710
性别（男性/女性） 47/35 50/34 0.773
BMI 26.6±2.1 27.3±2.9 0.063
结石分布（左/右） 50/32 57/27 0.684
结石大小（cm，
±s）		 2.6±0.5 2.7±0.4 0.425
CT值（Hu，
±s）		 1040±232 1077±223 0.304
表2 手术结果
CAE VAE P值
穿刺肾盏[例（%）] 0.187
上盏 27（32.9） 36（42.9）
中盏 55（67.1） 48（57.1）
建立通道时间（min，
±s）		 7.2±1.4 4.9±1.0 0.001
建立通道成功率（%） 82（82/100） 93.3（84/90） 0.019
血红蛋白下降（g/L，
±s）		 13.1±4.5 9.1±1.4 0.001
内镜手术时间（min，
±s）		 60.6±56.8 43.2±10 0.006
术后住院时间（d） 4（3~9） 3（2~5） 0.001
术后1月手术成功率[例（%）] 73.2（60/82） 86.9（73/84） 0.027
表3 围手术期并发症[例（%）]
CAE组 VAE组 P值
并发症 11（9/82） 3.6（3/84） 0.078
Clavien-Dindo grade Ⅰ/Ⅱ 4.9（4/82） 3.6（3/84） 0.718
Clavien-Dindo grade Ⅲ/Ⅳ 6.1%（5/82） 0（0/84%） 0.028
1
Su B, Song H, Yang Z, et al. Ultrasound-guided renal access and balloon dilation for PCNL in the prone position: results of a multicenter prospective observational study [J]. World J Urol, 2022, 40(9): 2339-2345.
2
张军晖, 张际青, 蒋宇光, 等. 可视球囊扩张导管在经皮肾镜取石术中的应用(附20例报告) [J]. 中国内镜杂志, 2019, 25(3): 74-77.
3
Dong SW, Hu SW, Liu SP, et al. A safe and effective two-step tract dilation technique in totally ultrasound-guided percutaneous nephrolithotomy [J]. Urol J, 2022, 19(6): 420-426.
4
Alken P. Percutaneous nephrolithotomy - the puncture [J]. BJU Int, 2022, 129(1): 17-24.
5
Mazzon G, Claps F, Germinale F, et al. Learning curve for endoscopic combined intra-renal surgery using vacuum-assisted device [J]. Urol Int, 2023, 107(4): 413-421.
6
Tanriverdi O, Boylu U, Kendirci M, et al. The learning curve in the training of percutaneous nephrolithotomy [J]. Eur Urol, 2007, 52(1): 206-211.
7
Zhang J, Kang N, Jiang Y, et al. Microperc with self-assembled Fr 4.85 visual needle and ureteral access sheath [J]. J Invest Surg, 2022, 35(3): 569-576.
8
Beiko D, Razvi H, Bhojani N, et al. Techniques - Ultrasound-guided percutaneous nephrolithotomy: How we do it [J]. Can Urol Assoc J, 2020, 14(3): E104-E110.
9
张际青, 张军晖, 康宁, 等. 自制F4.85可视穿刺针联合输尿管通道鞘在超微经皮肾镜碎石术中的应用 [J]. 中华泌尿外科杂志, 2017, 38(11): 852-856.
10
Wang Z, Zhang L, Wan L, et al. Clinical analysis of ultrasound-guided "tract without bleeding vessel requiring embolization (TBVE)" in reducing bleeding during percutaneous nephrolithotomy [J]. BMC Urol, 2025, 25(1): 192.
11
Shah AK, Xu K, Liu H, et al. The "visual dilator system": initial experimental evaluation of an optical tract dilation technique in percutaneous nephrolithotomy [J]. J Endourol, 2013, 27(7): 908-913.
12
Zhou M, He X, Zhang Y, et al. Optical puncture combined with balloon dilation PCNL vs. conventional puncture dilation PCNL for kidney stones without hydronephrosis: a retrospective study [J]. BMC Urol, 2019, 19(1): 122.
13
Lu Z, Yang W, He W. Learning curve of ultrasound-guided percutaneous nephrolithotripsy in the treatment of complex renal calculi [J]. J Int Med Res, 2024, 52(3): 3000605241239026.
14
Song Y, Ma Y, Song Y, et al. Evaluating the learning curve for percutaneous nephrolithotomy under total ultrasound guidance [J]. PLoS One, 2015, 10(8): e0132986.
15
de la Rosette JJ, Opondo D, Daels FP, et al. Categorisation of complications and validation of the Clavien score for percutaneous nephrolithotomy [J]. Eur Urol, 2012, 62(2): 246-255.
16
Birowo P, Rustandi R, Risky Raharja PA, et al. The learning curve for a single surgeon using ultrasonography to guide supine percutaneous nephrolithotomy with an alken metal telescopic dilator [J]. Heliyon, 2022, 8(12): e12524.
17
Eslahi A, Hosseini MM, Ahmed F, et al. Totally ultrasound-guided minimally invasive percutaneous nephrolithotomy in children: Is it safe? [J]. Afr J Paediatr Surg, 2022, 19(2): 68-72.
18
Tan C, Li X, Zhang X, et al. Ultrasound-guided percutaneous nephrolithotomy without fluoroscopy: early surgical experience with video-based technical insights [J]. Front Surg, 2025, 12: 1706729.
19
Tzou DT, Tailly TO, Stern KL. Ultrasound-guided PCNL - Why are we still performing exclusively fluoroscopic access? [J]. Curr Urol Rep, 2023, 24(7): 335-343.
20
Nedbal C, Cerrato C, Jahrreiss V, et al. The role of 'artificial intelligence, machine learning, virtual reality, and radiomics' in PCNL: a review of publication trends over the last 30 years [J]. Ther Adv Urol, 2023, 15: 17562872231196676.
21
Yu W, Rao T, Li X, et al. The learning curve for access creation in solo ultrasonography-guided percutaneous nephrolithotomy and the associated skills [J]. Int Urol Nephrol, 2017, 49(3): 419-424.
22
Jin W, Song Y, Fei X. The Pros and cons of balloon dilation in totally ultrasound-guided percutaneous nephrolithotomy [J]. BMC Urol, 2020, 20(1): 82.
23
Gutiérrez-Tapia D, García-Padilla MÁ, Ríos-Melgarejo C, et al. Nefrolitotomía percutánea totalmente guiada por ultrasonido: una técnica seguray eficiente [Totally ultrasound guided percutaneous nephrolithotomy: An efficient and safe technique] [J]. Rev Med Inst Mex Seguro Soc, 2025, 63(5): e6701. Spanish.
24
Usawachintachit M, Tzou DT, Washington SL 3rd, et al. Ultrasound-guided renal access and tract dilation [J]. Videourology (New Rochelle), 2017, 31(1): vid.2016.0046.
25
Kawahara T, Ito H, Terao H, et al. Ureteroscopy assisted retrograde nephrostomy for complete staghorn renal calculi [J]. Curr Urol, 2012, 6(2): 102-105.
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