3种人造肾积水方法在经皮肾镜取石术中的应用

目的 对比3种人造肾积水在经皮肾镜取石术中的应用效果。方法 选取武汉市第八医院2020年5月至2022年4月行单通道经皮肾镜取石术患者120例，按人造肾积水方式不同均分为A组、B组、C组。A组患者采用术前留置输尿管导管，通过输尿管导管注入生理盐水，扩张肾盂形成人造肾积水；B组患者术前留置双J管，经导尿管灌注生理盐水充盈膀胱，通过双J管返流扩张肾盂形成人造肾积水；C组患者通过静脉注射呋塞米，采用刺激性利尿的方法主动扩张肾盂形成人造肾积水。对比三组人造肾积水后行经皮肾镜取石术的一次性穿刺成功率、通道建立时间、整体手术时间、结石清除率及手术并发症发生率。结果 三组患者手术均顺利完成，A组及B组患者一次性穿刺成功率、通道建立时间差异无统计学意义（P>0.05），均高于C组（P<0.05）；B组患者的整体手术时间短于A组及C组（P<0.05）；三组患者的结石清除率及手术并发症比较，差异无统计学意义（P>0.05）。结论 术前留置双J管制造人工肾积水具有一次性穿刺成功率高、通道建立时间及手术时间短等优势。

Application of three artificial kidney hydronephrosis methods in percutaneous nephrolithotripsy

Objective To compare the effects of three kinds of artificial hydronephrosis in percutaneous nephrolithotomy. Methods A total of 120 patients who underwent single-tract percutaneous nephrolithotomy in the Eighth Hospital of Wuhan from May 2020 to April 2022 were selected and divided equally into three groups according to different methods of artificial hydronephrosis. Patients in group A were received preoperative indwelling ureteral catheter and injection of normal saline through ureteral catheter to dilate renal pelvis and form artificial hydronephrosis. Patients in Group B were placed with double J catheters before surgery, and the bladder was filled with physiological saline through the catheter. The renal pelvis was dilated through the double J catheters, resulting in artificial hydronephrosis. Patients in Group C were received intravenous injection of furosemide and stimulated diuretic method to actively dilate renal pelvis to form hydronephrosis. The one-time puncture success rate, channel establishment time, overall operation time, stone clearance rate and incidence of surgical complications of percutaneous nephrolithotomy after hydronephrosis were compared among the three groups. Results The operation was successfully completed in the three groups. There was no significant difference in the one-time puncture success rate and channel establishment time between group A and group B (P>0.05), which were all higher than group C (P<0.05). The overall operation time of group B was shorter than that of group A and group C (P<0.05). There were no significant differences in stone clearance rate and surgical complications among the three groups (P>0.05). Conclusion Preoperative indwelling of double J tubes to create artificial kidney hydronephrosis has advantages such as high success rate of one-time puncture, short channel establishment time, and surgical time.