双镜联合治疗复杂性肾结石

发布时间：2019-03-09 15:18

【摘要】：目的探讨经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石的临床疗效。方法选取2014年10月~2015年10月复杂性肾结石40例,随机分为观察组和对照组,每组20例。观察组采用皮肾镜联合输尿管软镜钬激光碎石术,对照组采用经皮肾镜取石术,比较2组手术时间、术中出血量、住院时间、一期手术结石清除率、术后并发症发生率等情况。结果 40例手术均顺利完成。观察组手术时间明显短于对照组[(80.2±12.0)min vs.(104.4±9.7)min,t=-7.014,P=0.000],2组术中出血量[(109.6±7.1)ml vs.(112.7±5.6)ml,t=-1.533,P=0.134]和住院时间差异无显著性[(6.8±1.3)d vs.(7.0±1.1)d,t=-0.525,P=0.602]。观察组一期手术结石清除率明显高于对照组[85.0%(17/20)vs.50.0%(10/20),Fisher精确检验,P=0.020],并发症发生率明显低于对照组[10.0%(2/20)vs.45.0%(9/20),Fisher精确检验,P=0.015]。随访3个月,观察组2例二期行体外震波碎石术(extracorporeal shock wave lithotripsy,ESWL),对照组4例,2组比较无统计学差异(Fisher精确检验,P=0.331);对照组二期行经皮肾镜取石术3例,观察组无一例,2组比较无统计学差异(Fisher精确检验,P=0.115)。术后1、3个月复查,2组结石清除率无显著差异[90.0%(18/20)vs.75.0%(15/20),Fisher精确检验,P=0.204;95.0%(19/20)vs.90.0%(18/20),Fisher精确检验,P=0.500]。结论经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石疗效显著,具有结石清除率高、并发症少等优点,值得临床推广应用。
[Abstract]:Objective to evaluate the clinical effect of percutaneous nephrolithotripsy combined with ureteroscopic holmium: YAG laser lithotripsy in the treatment of complicated renal calculi. Methods from October 2014 to October 2015, 40 patients with complicated renal calculi were randomly divided into observation group and control group with 20 cases in each group. The observation group was treated with percutaneous nephroscopy combined with holmium: YAG laser lithotripsy under soft ureteroscope, and the control group was treated with percutaneous nephrolithotripsy. The operative time, intraoperative bleeding volume, hospitalization time, primary stone clearance rate and postoperative complication rate were compared between the two groups. Results the operation was successfully completed in all 40 cases. The operative time in the observation group was significantly shorter than that in the control group [(80.2 卤12.0) min vs. (104.4 卤9.7) min,t=-7.014,P=0.000], and the intraoperative bleeding volume in the two groups [(109.6 卤7.1) ml vs. (112.7 卤5.6ml,) ml,]. There was no significant difference in the length of hospital stay [(6.8 卤1.3) d vs. (7.0 卤1.1) d, t = 0.525, P = 0.602]. The stone clearance rate of primary operation in the observation group was significantly higher than that in the control group [85.0% (17 / 20) vs.50.0% (10 ~ 20), Fisher, P < 0.020)]. The incidence of complications was significantly lower in the control group than in the control group [10.0% (2 / 20) vs.45.0% (9 / 20), Fisher precision test, P < 0.015)]. After 3 months of follow-up, two patients in the observation group underwent extracorporeal shock wave lithotripsy (extracorporeal shock wave lithotripsy,ESWL) and 4 patients in the control group. There was no significant difference between the two groups (Fisher exact test, P < 0. 331). Three patients in the control group underwent percutaneous nephrolithotomy in the second stage, and none in the observation group. There was no statistical difference between the two groups (Fisher exact test, P < 0. 115). 1 and 3 months after operation, there was no significant difference in stone clearance rate between the two groups [90.0% (18 / 20) vs.75.0% (15 / 20), Fisher, P = 0.204); 95.0% (19 / 20) vs.90.0% (18 脳 20), Fisher accurate test, P = 0.500). Conclusion Percutaneous nephrolithotripsy combined with ureteroscopic holmium: YAG laser lithotripsy is effective in the treatment of complicated renal calculi and has the advantages of high stone clearance rate and few complications. It is worth popularizing and applying in clinical practice.
【作者单位】：昆明医科大学第二附属医院泌尿外科云南省泌尿外科研究所;
【基金】：云南省科技惠民计划项目(项目编号:2014RA067) 云南省教育厅科学研究基金重点项目(项目编号:2014Z052)
【分类号】：R699.2

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