在超声导向标准接入的皮肤利切除术中,对于复杂的结石来说,非皮质穿孔是否安全和可行?
Bo Xiao1, Yang Chen1, Sen Lin1
1Department of Urology, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China.
Journal of endourology
|November 28, 2025
概括
对于复杂的结石,超声波引导的穿皮腎石切除术 (PCNL) 通过胞穿孔更安全,更有效. 非乳头穿刺导致出血增加和无结石率降低,使其不那么理想.
科学领域:
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 医疗成像医学成像
背景情况:
- 透皮骨切除术 (PCNL) 是复杂结石的标准治疗方法.
- 超声波 (US) 指导越来越多地用于PCNL程序.
- 美国指导的PCNL的最佳穿孔部位仍然是调查的主题.
研究的目的:
- 评估非乳头穿刺与乳头穿刺在复杂结石的标准访问PCNL中的安全性和可行性.
- 为了比较 papillary 和 non-papillary 穿刺组之间的无石头率 (SFR) 和出血并发症.
- 确定美国指导的PCNL在复杂脏计算中的最佳穿孔策略.
主要方法:
- 对218名患有复杂结石的患者 (Guy的得分系统3-4) 进行标准访问PCNL的回顾性审查.
- 患者被分为两组:乳头穿刺 (n=182) 和非乳头穿刺 (n=36).
- 所有手术都采用了全超声波指导和单一标准接入 (22-24 F).
主要成果:
- 乳头穿孔组的无结石率显着更高 (81.3%对69.4%,p=0.03).
- 非乳头穿刺组的血红蛋白损失显著增加 (18.4 g/L与10.4 g/L,p=0.02).
- 在乳头穿刺组 (p=0.02,0.03) 观察到较低的非严重并发症率 (Clavien-Dindo级别1-2).
结论:
- 通过标准接入通道进行超声导向的PCNL需要膜穿孔以获得最佳结果.
- 非乳头穿刺与增加出血和减少无结石率有关.
- 尽可能避免在复杂的结石中进行非乳头穿刺,以改善手术结果.
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