Study on the safety and effectiveness of complete ultrasound-guided and ultrasound-guided percutaneous renal balloon dilatation
Objective To compare the safety and effectiveness of percutaneous nephrolithotomy(PCNL)using complete ultrasound guided balloon dilation and ultrasound combined with X-ray guided balloon dilation.Methods A retrospective analysis was conducted on the clinical data of 992 patients with kidney stones admitted to the First Hospital of Jilin University from May 2015 to May 2022 who underwent balloon dilation PCNL.According to different surgical methods,they were divided into complete ultrasound guided PCNL(complete ultrasound group)and ultrasound combined with X-ray guided PCNL(ultrasound combined with X-ray group),with 395 cases in the complete ultrasound group and 597 cases in the ultrasound combined with X-ray group.Gender of patients in the complete ultrasound group and ultrasound combined with X-ray group[male/female:208/187 cases and 329/268 cases],age[(43.2±11.8)years and(42.8±12.5)years],body mass index[(22.8±2.6)kg/m2 and(22.6±3.1)kg/m2],ASA score[1/2/3:174/189/32 cases and 277/273/47 cases],location of stones(left/right:207/188 casesand 302/295 cases),Guy's score[Ⅰ/Ⅱ/Ⅲ/Ⅳ:56/115/141/83 cases and 88/198/209/102 cases],length of stones[(4.7±0.9)cm and(4.8±1.1)cm],the degree of hydronephrosis[no/mild/moderate/severe:75/162/103/55 cases and 88/266/175/58 cases]and the previous history of percutaneous kidney surgery[39 cases and 45 cases]were not significantly different(P＞0.05).All patients underwent balloon dilation PCNL under general anesthesia,and were placed in a prone position.The complete ultrasound group only underwent real-time ultrasound monitoring of the entire process of puncture and dilation,without X-ray monitoring.The ultrasound combined with X-ray group performed puncture under real-time ultrasound guidance,while monitoring the puncture and dilation process by X-ray.Two groups underwent routine indwelling of double J tubes and nephrostomy tubes after surgery.The puncture success rate,dilation success rate,surgical time,stone clearance rate,and postoperative complications were compared between the two groups.Results Compared with the ultrasound combined with X-ray group,the puncture success rate of the complete ultrasound group was also 100％,the one-time expansion success rate of the complete ultrasound group was 95.9％(379/395),and it was 95.8％(572/597)in the ultrasound combined with X-ray group.Both groups of patients were able to establish multiple pathways during surgery,with 72 patients(18.2％)in the complete ultrasound group and 102 patients(17.1％)in the ultrasound combined with X-ray group establishing ≥ 2 pathways(P=0.64).The immediate postoperative stone free rates were 88.9％and 90.0％,respectively(P=0.58).The average operative time was(58.2±11.5)minutes and(61.1±10.8)minutes,respectively.The postoperative hospital stay was(4.2±1.1)days and(4.3±1.2)days,respectively.In the complete ultrasound group and the ultrasound combined with X-ray group,there were 27 and 40 cases(P=0.93)with transient fever of Clavien Dindo grade Ⅰ complication,7 and 11 cases(P=0.93)with blood transfusion and 29 and 42 cases(P=0.91)with special anti-inflammatory treatment of grade Ⅱ complication 3 and 4 cases(P=0.87)requiring embolization treatment of grade Ⅲ complication,and 2 cases(P=0.68)requiring ICU treatment of grade Ⅳ complication.Two groups were followed up for 1 month after surgery,and there was no recurrence of stones.Conclusions Both complete ultrasound guided and ultrasound combined with X-ray guided percutaneous nephrolithotomy have the characteristics of high success rate in puncture and dilation,high stone clearance rate,and fewer postoperative complications.The two methods have similar effectiveness and safety.
万方数据
维普
