刘佛林+邹毓华++徐瑞权++袁源湖++伍耿青++谢昆林

[摘要]目的 探讨B超引导改良两步扩张法建立皮肾通道经皮肾镜取石术（PCNL）治疗非积水肾结石的方法和安全性，评价其临床价值。方法 选取2016年1～12月我院收治的80例非积水肾结石患者作为研究对象，随机分成A组和B组，每组40例。A组采用B超引导改良两步扩张法建立皮肾通道PCNL治疗，B组采用常规B超引导逐级扩张法的PCNL治疗，比较两组的通道成功率、通道建立时间、手术时间﹑平均失血量﹑住院时间﹑结石清除率、并发症发生率等。结果 A组与B组的结石清除率及住院时间比较，差异无统计学意义（P>0.05）。A组的通道成功率高于B组，通道建立时间、手术时间短于B组，失血量少于B组，差异有统计学意义（P<0.05）。两组的并发症发生率比较，差异无统计学意义（P>0.05）。结论 B超引导改良两步扩张法建立皮肾通道PCNL治疗非积水肾结石安全、可行，效果确切，具有通道建立简单、通道成功率高、手术时间短、出血少等优点，值得推广。

[关键词]二步扩张法；皮肾通道；经皮肾镜取石术；非积水肾结石

[中图分类号] R692.4 [文献标识码] A [文章编号] 1674-4721（2017）04（a）-0068-04

[Abstract]Objective To investigate the method and safety of percutaneous nephrolithotomy （PCNL） with renal access created by modified B ultrasound guided two-step dilation in the treatment of non-hydronephrosis renal calculus，and to evaluate its clinical value.Methods From January to December in 2016，80 patients with non-hydronephrosis renal calculus in our hospital were selected and randomly divided into group A and group B，40 cases in each group.Group A was treated with PCNL with renal access created by modified B ultrasound guided two-step dilation，group B was treated with PCNL with conventional B ultrasound guided gradual dilation.The success rate of renal access，renal access creation time，operation time，the average blood loss，hospitalization time，the calculus clearance rate and the incidence rate of complications between the two groups were analyzed and compared respectively.Results There was no significant difference between A group and B group in the stone clearance rate and hospital stay （P>0.05）.The success rate of group A was higher than that of group B，channel establishment time，operation time of group A was shorter than that group B，the blood loss of group A was less than of group B，with significant difference （P<0.05）.There was no significant difference in the incidence rate of complications between the two groups （P>0.05）.Conclusion PCNL with renal access created by modified B ultrasound guided two-step dilation in the treatment of non-hydronephrosis renal calculus is safe and feasible，the effect is significant，it has some advantages of simple channel，high success rate，shorter operation time and less bleeding，it is worthy of promotion.

[Key words]Two-step dilate；Renal access；Percutaneous nephrolithotomy；Non-hydronephrosis renal calculus

经皮肾镜取石术（percutaneous nephrolithotripsy，PCNL）在上尿路结石治疗中发挥重要作用，已逐渐取代传统开放手术成为治疗肾结石的一线方法[1-2]。如何建立安全、合理、有效的经皮肾穿刺通道，仍是PCNL技术的关键，特别对于复杂性肾结石或非积水肾结石，肾实质较厚、收集系统空间较小、结石负荷较大等均是影响通道建立的重要因素，其导致术中发生通道丢失、出血及其他并发症的可能性陡增[3-4]。PCNL术中穿刺技术、B超引导技术、通道扩张技术、体位变化、碎石技术等相关技术不断得到改良及优化，进而提高手术安全性及療效[5-9]。本……