超声造影技术引导下经皮肾穿刺应用于经皮肾镜取石术的单中心初步经验

目的：评估超声造影引导肾穿刺建立工作通道用于经皮肾镜取石术的有效性。方法：该回顾性研究纳入20例在北京大学第一医院诊断为肾结石的患者,患者的人口学基线数据、临床特点、手术治疗以及术后情况来自于北京大学第一医院综合病例数据库。全身麻醉后在超声造影技术实时监控下由同一泌尿外科医师进行经皮肾穿刺，再利用钬激光或气压弹道进行碎石,记录患者的基线临床资料、结石特征以及手术过程，最后，利用统计学分析方法评价超声造影引导经皮肾穿刺用于经皮肾镜取石术的安全性和有效性。结果：20例患者均在超声造影引导下成功行肾穿刺建立工作通道，并完成经皮肾镜取石手术。所有患者均成功穿刺入肾集合系统并建立良好的工作通道，仅1例患者接受了二次肾穿刺，并且所有患者均为通过肾中盏穿刺。中位穿刺时间3.9 min（四分位数：2.9~4.6 min），而中位手术时间是112 min（四分位数：98.5~134.5 min）。术后48 h的泌尿系平片 (kidney ureter bladder, KUB) 显示初步结石清除率为95.0%（19/20），而中位血红蛋白下降水平为10 g/L （四分位数：5.5~14.5 g/L）。2位患者术后出现暂时性发热,并且对抗生素反应良好,除此之外，无其他严重并发症出现。结论：对于处在经皮肾镜取石术手术学习曲线中的泌尿外科医师，使用注射用六氟化硫微泡超声造影引导经皮肾穿刺建立工作通道是一种安全且有效的方法。该技术使肾穿刺过程更加可视化且简单化，可获得相比于普通超声更为清晰的高质量图像。经皮肾镜取石术初学者可能从该项技术中获益从而缩短学习曲线，但是这需要进一步的前瞻性对比研究加以明确和证实。

Percutaneous renal access for percutaneous nephrolithotomy guided by contrast enhanced ultrasound: a single-center preliminary experience in China

Objective:Contrast enhanced ultrasound (CEUS) is an innovative technique that employs microbubble contrast agents to demonstrate parenchymal perfusion.Ultrasound contrast agent was reported to be directly used in human internal lumen to improve the observation capacity of ultrasound.However,CEUS has never been reported to be used in the guidance of percutaneous renal access in percutaneous nephrolithotomy (PCNL).This study aimed to assess the efficacy of CEUS-guided renal access in PCNL.Methods:In this retrospective study,percutaneous renal access was performed under real-time monitoring of CEUS during PCNL in a cohort of 20 patients with renal stones at Peking University First Hospital.Data regarding patients' demographic and clinical characteristics,therapeutic regimens,and postoperative information were collected from a comprehensive database containing comprehensive medical records of the patients undergoing PCNL.Briefly,the procedure was as follows.With the patient under general anesthesia,renal access was established by the guidance of CEUS.Afterwords,holmium laser,pneumatic or ultrasonic lithotripsy was used by the same urologist.The patient demographics,stone characteristics and procedure details were noted.Finally,appropriate statistical analyses were performed to evaluate the effectiveness and safety of the CEUS-guided percutaneous renal access in PCNL.Results:All the 20 patients underwent PCNL successfully with the help of CEUS guidance for tract creation.The collecting system was successfully accessed in all the patients,and only one patient underwent re-puncture.All the patients approached through a middle-pole percutaneous access.The median puncture time was 3.9 (2.9-4.6) min,and the median operating time was 112 (98.5-134.5) min.The preliminary stonefree rate of PCNL was 95.0％ (19/20) as shown by the kidney,ureter,and bladder (KUB) radiographs 48 h postoperation,and the median decline in hemoglobin level was 10 (5.5-14.5) g/L.Two patients had transient postoperative fever and responded well to antibiotics.In addition,no other major complications were observed.Conclusion:CEUS is a safe and effective alternative way of guidance for percutaneous renal access for PCNL beginners.It makes this procedure more visualized and simpler,and produces clearer images than common ultrasonic ones.PCNL beginners might benefit from this method to shorten the learning curve of PCNL,while it warrants further comparative studies to clarify.