可视扩张鞘联合针状肾镜经皮肾镜手术治疗肾结石的安全性和穿刺精准度分析

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ABSTRACT：ObjectiveTo compare the clinical efficacy of visual dilated sheath combined with needle nephroscope percutaneous nephrolithotomy （PCNL） with traditional PCNL for renal calculi，so as to enhance the intraoperative safety and puncture accuracy.MethodsA retrospective analysis was conducted on 100 patients with renal calculi treated on hospital during Sep.2022 to Sep.2023.Based on the surgical approaches，patients were divided into the needle nephroscope group （PCNL with visual dilator sheath and needle nephroscope，n=52） and traditional group （traditional PCNL，n=48）.Clinical characteristics，surgical parameters，and outcomes were compared between the two groups.ResultsThere were no significant differences between the two groups in baseline data，total operation time and hospital stay （P>0.05）.The needle nephroscope group had a longer channel establishment time compared to the traditional group [20.0（17.022.0） min vs.16.0 （15.021.0） min，P=0.002]，but significantly shorter puncture time [2.0 （1.02.6） min vs. 2.8（2.03.5） min，P<0.001]，and fewer adjustments of the puncture needle （9.6% vs. 64.6%，P<0.001）.The channel was successfully established on the first attempt in all patients in the needle nephroscope group，while only 41 of patients in the traditional group achieved success on the first attempt，6 cases needed 2 attempts，and 1 case needed 3 attempts.Postoperative complications were absent in the needle nephroscope group，whereas postoperative bleeding requiring interventional treatment occurred in 1 case in the traditional group.There was no significant difference in the first-stage stone-clearance rate between the two groups （88.4%vs.85.4%，P=0.872）.ConclusionPCNL using a visual dilator sheath combined with a needle nephroscope achieves a comparable first-stage stone-clearance rate to traditional PCNL.However，it offers significant advantages in terms of shorter puncture time，fewer adjustments of the puncture needle，and lower postoperative complication rate.These findings suggest superior safety and precision，making it a valuable technique for clinical application.

摘要：目的将传统扩张鞘改良为可视扩张鞘并比较其联合针状肾镜经皮肾镜取石术（PCNL）与传统PCNL治疗肾结石的临床效果，为提高术中安全性和穿刺精确度提供参考。（剩余8711字）