周晓帆 陈结能 徐耀滨 吴春志 蒋毅平 李嘉健

【摘要】 目的：探討超声引导下采用多通道统一穿刺方法经皮肾镜取石术（PCNL）治疗复杂性多发性肾结石的临床价值。方法：选取2019年3月-2020年8月本院收治的50例复杂性多发肾结石患者。按随机数字表法将其分为对照组与研究组，每组25例。两组均进行PCNL治疗，对照组进行超声定位多通道先后穿刺方法，研究组进行超声引导下多通道统一穿刺方法。比较两组一次穿刺成功率、一期成功取净结石率、一期取石时间、术中出血量、手术时间、住院时间及并发症发生情况。结果：观察组一次性穿刺成功率与一期成功取净结石率均高于对照组（P<0.05）。两组一期取石时间、术中出血量、手术时间及住院时间比较，差异均无统计学意义（P>0.05）。两组并发症发生率比较，差异无统计学意义（P>0.05）。结论：治疗复杂性多发肾结石采用超声引导下多通道统一穿刺方法，可避免PCNL术中灌洗液外渗及术中出血等因素对超声穿刺定位的影响，明显提高了一次穿刺成功率，增加了一期成功取净结石率，且对一期取石时间、术中出血量、手术时间、住院时间及并发症无明显影响，临床应用价值较高，值得推广。

【关键词】 超声引导 多通道 统一穿刺 经皮肾镜取石 复杂性多发肾结石

Clinical Application of Ultrasound-guided Multi-channel Unified Puncture Method PCNL in the Treatment of Complex Multiple Kidney Stones/ZHOU Xiaofan， CHEN Jieneng， XU Yaobin， WU Chunzhi， JIANG Yiping， LI Jiajian. //Medical Innovation of China， 2021， 18（01）： -145

[Abstract] Objective： To investigate the clinical value of Ultrasound-guided multi-channel unified puncture method percutaneous nephrolithotomy （PCNL） in the treatment of complex multiple kidney stones. Method： A total of 50 patients with complex multiple kidney stones admitted to our hospital from March 2019 to August 2020 were selected. According to the random number table method， they were divided into control group and study group， 25 cases in each group. Both groups were treated with PCNL. The control group underwent ultrasound localization multi-channel sequential puncture method， while the study group underwent ultrasound guided multi-channel unified puncture method. The success rate of one-stage puncture， rate of one-stage successful stone removal， one-stage stone removal time， intraoperative blood loss， operation time， hospital stay and complications were compared between the two groups. Result： The success rate of one-stage puncture and the rate of one-stage successful stone removal in the observation group were higher than those in the control group （P<0.05）. There were no statistically significant differences between the two groups in the time of one-stage stone removal， intraoperative blood loss， operative time and hospital stay （P>0.05）. There was no statistically significant difference in the incidence of complications between the two groups （P>0.05） Conclusion： In the treatment of complex multiple kidney stones， ultrasound-guided multi-channel unified puncture method can avoid the influence of factors such as extravasation of lavage fluid and intraoperative bleeding on the location of ultrasound puncture during PCNL. It can significantly improve the success rate of one-time puncture， increase the rate of one-stage successful stone removal， and have no obvious influence on the time of stone extraction， intraoperative blood loss， operation time， hospital stay and complications， which is worth popularizing.

[Key words] Ultrasound-guided Multi-channel Unified puncture Percutaneous nephrolithotomy Complex multiple kidney stones

First-authors address： Peoples Hospital of Taishan City， Taishan 529200， China

doi：10.3969/j.issn.1674-4985.2021.01.035

由于微创技术的逐步升级，仪器设备的不断改进，目前治疗泌尿系统结石主要多采用腔镜微创技术，现今较为成熟的微创取石方法是经皮肾镜取石术（PCNL），在处理复杂性多发肾结石时，PCNL已经成为首选的方式之一[1]。复杂性多发肾结石通常是指多发性结石、结石体积较大还有特殊类型的结石，如鹿角形结石等。PC……