经皮肾一步扩张法在结石所致梗阻性肾功能不全中的应用

目的 探讨超声引导下经皮肾一步扩张法在结石性梗阻性肾功能不全中的临床效果.方法 选择我院2009年7月～2011年7月因结石所致上尿路梗阻,合并梗阻性肾积液、肾功能不全患者68例,随机分为一步扩张法( One-step)组和逐步式(Multi- step)组分别行经皮肾穿刺微造瘘引流术,每组各34例.One-step组在超声引导下一步式经皮肾穿刺微造瘘(PCN)直接穿刺引流,Multi-step组采用传统Seldinger法逐级扩张经皮肾通道实施造瘘引流.对比观察两组患者建立经皮肾通道的手术时间、术中出血量、成功率、术后并发症及肾功能的变化情况.结果 One-step组手术时间、扩张次数、术中出血量均少于Multi-step组,差异有显著性(P＜0.05).One-step组一次穿刺置入造瘘管的成功率明显高于Multi-step组,而术后并发症发生率明显低于multi-step组,差异均有显著性(P＜0.05).两组患者术后肾功能明显改善,术后2周尿素氮(BUN)、血肌酐(Cr)与术前相比,差异有显著性(P＜0.05),但术后2周两组间BUN、Cr比较,差异无显著性(P＞0.05).结论 一步扩张法经皮肾穿刺微造瘘操作简便、创伤小、出血量少和并发症少,有助于改善梗阻性肾功能不全.

Application of one-step percutaneous nephrostomy in treating obstructive renal insufficiency caused by calculus

【Objective】 To explore the clinical effect of ultrasound-guided one-step percutaneous nephrostomy in treating obstructive renal insufficiency.【Method】 68 cases with renal insufficiency due to upper urinary tract obstruction were selected and randomly divided into two groups for percutaneous nephrostomy.34 cases in the on-step group were received the single-step percutaneous nephrostomy tube and 34 cases in the multi-step group were given fascial dilators serially for puncture.The operative time,time of dilatation,blood loss,success rate,postoperative complications and renal function changes were compared between the two groups.【Results】 The operative time,time of dilatation and blood loss in the one-step group were less than those of the multi-step group(P <0.05).The incidence rate of postoperative complication in the one-step group was significantly lower than that of the multi-step group(P <0.05).Postoperative renal function was improved in all patients.The level of urea nitrogen(BUN) and creatinine(Cr) two weeks after operation were significantly improved than those before operation in two groups(P <0.05).There was no significant difference of the level of BUN and Cr between the two groups two weeks after operation(P >0.05).【Conclusion】 One-step percutaneous nephrostomy is simple method in treating obstructive renal insufficiency with less trauma,less blood loss and fewer complications.