球囊扩张器应用于超声引导微创经皮肾镜取石术的临床研究

目的：评价球囊扩张器应用于超声引导下的微创经皮肾镜治疗肾结石的有效性和安全性.球囊扩张是经皮肾镜通道扩张的常用方法之一.但已有的报道中,球囊扩张器都是在放射线引导下应用的.方法：回顾性分析2010年1月至11月哈尔滨医科大学附属第一医院泌尿外科接受应用球囊扩张器的超声引导下经皮肾镜取石术的50例患者.统计的数据包括患者年龄、性别、结石载量、通道建立时间、出血量、副损伤及其他并发症发生情况等.结果：所有的经皮肾镜通道建立均一次成功.平均通道建立时间（13.66±1.42）min（10~15min）.结石完全清除者占84.00%（42/50）,基本清除者占4.00%（2/50）,总清除率88.00%（31/50）.未发生胸膜损伤、结肠损伤和肾脏集合系统的破裂伤.术中血红蛋白下降幅度（5.49±2.64）g/L.结论：超声引导下球囊扩张器应用于微创经皮肾镜术是完全可行的.该方法能够保证成功建立通道,并且有助于清除结石、保证较低的出血量和副损伤发生率.

Ultrasound-guided Balloon Dilation in Minimally Invasive Percutaneous Nephrolithotomy for Treatment of Renal Calculi

Objective： To evaluate the effectiveness and safety of ultrasound-guided balloon dilation in minimally invasive percutaneous nephrolithotomy（PCNL） for the treatment of renal calculi.Compared with metal and sequential fascial dilators,balloon dilators have certain advantages and are widely utilized in percutaneous nephrolithotomy.However,because balloon dilators are usually used under fluoroscopic guidance,they can be troublesome for urologists who are more accustomed to working under ultrasound guidance.Methods： Fifty patients with renal calculi were enrolled.These patients underwent ultrasound-guided percutaneous nephrolithotomy using balloon dilators.Preoperative and postoperative evaluations of calculi included color ultrasound,plain abdominal radiography,and intravenous urography.The intraoperative blood loss was evaluated by analyzing the decrease in hemoglobin compared with the baseline level.Manipulation speed was measured by tract establishment duration and operation duration.Results： These patients were matched in terms of age,gender,calculi location and burden.Tracts in all patients were successfully established in the first attempt and no rupture of the colon,pleura,or renal collection system occurred.Duration of cannulation were 13.66±1.42min（10~15min）,stone-free rate were 84.00%（42/50）,intraoperative blood loss were 5.49 ± 2.64g/L.Conclusion： Ultrasound-guided balloon dilation is feasible in minimally invasive percutaneous nephrolithotomy.It can ensure successful tractestablishment and operation duration,intraoperative blood loss and blood transfusion,and clearance of residual stone fragments.