The Clinical Application Of Ultrasound Armed With Professional Convex Probe For The Establishment Of Percutaneous Renal Access In The Process Of Percutaneous Nephrolithotomy

Objective:To evaluate the clinical value of ultrasound armed with professional convex probe for the guidance of percutaneous renal puncture to establish working channel in percutaneous nephrolithotomy.Methods:177 cases who underwent PCNL using ultrasound armed with professional convex probe for the guidance of percutaneous renal puncture in the First Affiliated Hospital of Guangxi Medical University from January 2014 to January 2015 were included in our study, marked as the group A. Of them, 112 were male and 65 were female. In addition,152 cases who underwent PCNL using the ultrasound with general probe or X-ray for the guidance of percutaneous renal puncture in the same hospital from January 2010 to January 2012 were selected as the control, marked as the group C. Of them,95 were male and 57 were female. The clinic data were recorded and statistically analyzed, including the time of establishment of percutaneous renal access, the approach of renal calyx, the operation time, the blood loss in operation, the complications, the clearance rates, and the postoperative stay.Results:The establishment of renal access and the PCNL were successfully finished for all the patients. For group A, the time of establishment of percutaneous renal access was 10.36±2.54 min. For the approach of renal calyx, upper renal calyx puncture were established in 84 cases, middle renal calyx puncture in 72 cases, and lower renal calyx puncture in 21 cases; Among them, dual channel in 7 cases,4 cases with three channels. The mean operation time was (70.61±20.23) min (41-177min), and the mean blood loss was (41.76±31.97) ml (5～200ml). The mean postoperative stay was (5.75±2.09) d, and the clearance rates was 88.14%. For the complications, pneumothorax occurred in 2 patients and they were relieved by conservative treatment. Fever occurred in 6 patients, postoperative bleeding occurred in 8 patients and 7 of them were relieved by conservative treatment, and one patient received renal artery embolization. There was one patients accpted open surgery for the massive hemorrhage during PCNL.For group C, the time of establishment of percutaneous renal access was 15.08±3.18 min. For the approach of renal calyx, upper renal calyx puncture were established in 55 cases, middle renal calyx puncture in 73 cases, and lower renal calyx puncture in 24 cases; Among them, dual channel in 9 cases,4 cases with three channels. The mean operation time was (81.13±19.71) min (45～120 min), and the mean blood loss was (67.76±39.66) ml (5～200ml). The mean postoperative stay was (6.19±2.46) d, and the clearance rates was 80.26%. For the complications, pneumothorax occurred in 1 patients and she was relieved by conservative treatment. Fever occurred in 6 patients, postoperative bleeding occurred in 8 patients and were relieved by conservative treatment.There were significant differences between the two groups in the time of establishment of percutaneous renal access, the approach of renal calyx, the operation time, the blood loss in operation, the postoperative stay and the clearance rates. Complications in two groups were not statistically significant.Conclusion:It is safe and effective to establish a working channel guided by the ultrasound armed with professional convex probe in the process of PCNL.