摘要目的 探讨超声引导下经皮肾镜取石术中行输尿管插管制造人工肾积水的必要性.方法 对2016年1月至2017年5月温州医科大学附属第一医院泌尿外科收治的肾积水为5～ 20 mm并符合纳入排除标准的肾或输尿管上段结石病例行前瞻性随机对照研究.入组的291例患者按术前肾盂分离程度(5～＜10 mm、10～20 mm)分2层进行试验,每层均分为人工肾积水组与非人工肾积水组,人工肾积水组术中留置5F输尿管导管,人工肾积水后行俯卧位肾穿刺碎石;非人工肾积水组直接俯卧位肾穿刺碎石.分别采用t检验、x2检验、重复测量方差分析比较两组手术结果.结果 全部患者中4例术中因脓肾改行二期手术,予以剔除.5～＜10 mm层人工肾积水组和非人工肾积水组的术后发热率(14.6％比4.8％,x2=5.07,P=0.03)、手术时间[(65.7±9.9) min比(50.3±7.4) min,t=11.47,P=0.00],医疗费用[(18 327±903)元比(14 583±784)元,t=24.50,P=0.00]差异有统计学意义;10～20mm层人工肾积水组和非人工肾积水组的术后发热率(14.5％比3.39％,x2=4.53,P=0.03)、手术时间[(66.0±9.9)min比(52.4±8.9)min,t=8.30,P=0.00],医疗费用[(16 548±537)元比(13 102±629)元,t=32.10,P=0.00]差异有统计学意义.各层两组的一针穿刺成功率、结石碎片下移输尿管肾镜处理失败数、顺行双J管留置失败率、结石清除率等均无差异.2例因术后出血量较大予输血,经数字减影血管造影动脉栓塞后痊愈;4例顺行留置双J管困难,经超滑导丝引导后留置成功;4例结石碎片下移输尿管肾镜处理失败,均通过输尿管镜成功处理.未发生感染性休克及周围器官损伤等严重并发症.结论 超声引导下经皮肾镜取石术治疗肾积水为5 ～ 20 mm的肾或输尿管上段结石时,经验丰富的术者可尝试不常规进行人工肾积水.

abstractsObjective To investigate the necessity of artificial kidney seeper which made through inserting a ureteral tube in the ureter to the ultrasonography-guided percutaneous nephrolithotomy (PCNL).Methods This was a randomized prospective study.Patients who conformed to the inclusion and exclusion criteria were enrolled at Department of Urology,Frist Affiliated Hospital of Wenzhou Medical University from January 2016 to May 2017.Totally 291 patients were included in the study.Patients were randomly assigned into two groups (artificial kidney seeper group and non-artificial kidney seeper group) in different kidney seeper level (5 to ＜ 10 mm,10 to 20 mm) respectively.The artificial kidney seeper group was inserted by a ureteral cathedral,then were underwent the ultrasonography-guided PCNL in prone position.The non-artificial kidney seeper group were underwent the ultrasonography-guided PCNL in prone position directly.The t test,x2 test,repeated measure analysis was used to data measurement,respectively.Results Four patients who diagnosed pyonephrosis were excluded.On the 5 to ＜ 10 mm level,fever rate (14.6％ vs.4.8％,x2 =5.07,P =0.03),operation time ((65.7 ± 9.9) min vs.(50.3± 7.4) min,t =11.47,P =0.00),cost ((18 327±903) yuan vs.(14 583± 784) yuan,t =24.50,P=0.00) about artificial kidney seeper group and non-artificial kidney seeper group had statistical differences.And on the 10 to 20 mm level,fever rate (14.5％ vs.3.39％,x2 =4.53,P=0.03),operation time ((66.0±9.9) min vs.(52.4± 8.9)min,t=8.30,P=0.00),cost ((16 548±537) yuan vs.(13 102±629) yuan,t=32.10,P=0.00) about artificial kidney seeper group and non-artificial kidney seeper group had statistical differences.And there were no statistical differences in the success rate of puncturing,the failures of the treatment to the stone pieces falling into the ureter and clearance rate of the stone and so on.In this study,2 cases recovered after received transfusion and digital subtraction angiography artery embolization treatments;D-J tube was indwelled into 4 cases guiding by super smooth thread;4 cases were finished the surgeries with the help of ureteroscopy,because the stone pieces fell into the ureter during the surgeries.And there was no patients developing septic shock,adjacent viscera injury or other serious complications.Conclusion For seasoned doctors,there is no necessity of regularly artificial kidney seeper for PCNL when the pre-operation seeper ranging from 5 to 20 mm.