单通道微创经皮肾镜碎石联合顺行输尿管软镜碎石治疗复杂性肾结石临床观察

发布时间：2019-03-28 07:08

【摘要】：背景复杂性肾结石[1]是指鹿角形肾结石、多发性肾结石,伴有肾盏颈狭窄和肾盏扩张以及并发肾盏解剖异常的结石,如马蹄形肾结石、海绵肾结石等。复杂性肾结石治疗一直是泌尿外科较为棘手的问题,保持长期的无石率,降低结石复发率和感染率,积极保护肾功能是其治疗目的。随着泌尿外科微创技术的快速发展,经皮肾镜碎石术(Percutaneous nephroscope lithotripsy,PCNL)成为复杂性肾结石首选的治疗方案,尤其是在处理多发结石与大型结石方面具有显著成效,标准通道经皮肾镜碎石效果高,但标准通道较粗,摆动时容易出血盏颈撕裂,导致出血。在此基础上出现了微创经皮肾镜碎石术(Minimally invasive percutaneous nephroscope lithotripsy,MPCNL)。单通道MPCNL气压弹道碎石术往往无法完全发现或彻底清除结石。多通道取石术可获得较高的结石清除率,但易损伤肾实质,增加并发症。故如何减少手术创伤,提高结石清除率成为临床关注的焦点。目的探讨单通道微创经皮肾镜气压弹道碎石联合输尿管软镜钬激光碎石治疗复杂性肾结石的临床疗效和安全性。方法将2015年3月至2016年7月我院收治的96例复杂性肾结石患者随机分为两组,每组各48例。对照组单用单通道MPCNL气压弹道碎石治疗,观察组单通道MPCNL气压弹道碎石联合输尿管软镜钬激光碎石治疗。所有患者术前均行泌尿系平片、泌尿系彩超检查、静脉泌尿系造影或CTU。两组患者年龄、性别、结石大小、尿常规白细胞阳性率、尿培养阳性率无统计学差异。统计分析两组患者结石清除率、手术时间、术后血红蛋白变化、术后感染率、术后尿液转清时间、并发症发生率以及住院时间、住院费用等资料。结果观察组结石取净率93.75%(45/48)明显高于对照组77.10%(37/48),差异显著(P0.05);观察组手术时间(58.1±25.2min)较对照组手术时间(46.8±20.5min)延长,具有统计学意义(P0.05);观察组与对照组相比术中出血、术后感染、术后尿液转清时间均无统计学意义(P0.05)。术后30min血白细胞较术前无明显统计学意义,术后1h、2h较术前白细胞升高(P0.05)。术前尿常规白细胞异常术后感染发生率高,具有统计学意义(P0.05)。观察组与对照组相关住院费用增加(P0.05),但住院时间无明显延长(P0.05)。结论单通道MPCNL气压弹道碎石联合肾造瘘输尿管软镜钬激光碎石治疗复杂性肾结石疗效确切,明显提高结石清除效果。
[Abstract]:Background complex renal calculi [1] are staghorn kidney stones, multiple kidney stones, accompanied by renal calyceal neck stricture and renal calyceal dilatation, and complicated with renal calyceal anatomical abnormalities, such as horseshoe-shaped kidney stones, cavernous kidney stones, and so on. The treatment of complex renal calculi has always been a thorny problem in urology. To maintain a long-term stone-free rate, reduce the recurrence rate and infection rate of calculi, and actively protect renal function are the purposes of its treatment. With the rapid development of urological minimally invasive technique, percutaneous nephrolithotripsy (Percutaneous nephroscope lithotripsy,PCNL) has become the first choice for the treatment of complex renal calculi, especially in the treatment of multiple and large stones. The standard passageway has high effect of percutaneous nephrolithotripsy, but the standard channel is thicker, so it is easy to bleed breviscapus when swinging, which leads to bleeding. On this basis, minimally invasive percutaneous nephrolithotripsy (Minimally invasive percutaneous nephroscope lithotripsy,MPCNL) appeared. Single-channel MPCNL pneumatic lithotripsy often fails to completely detect or remove stones. Multi-channel lithotomy can obtain high stone clearance rate, but it is easy to injure renal parenchyma and increase complications. Therefore, how to reduce surgical trauma and improve stone clearance rate has become the focus of clinical attention. Objective to evaluate the clinical efficacy and safety of single-channel minimally invasive percutaneous nephrolithotripsy combined with ureteroscopic holmium: YAG laser lithotripsy in the treatment of complicated renal calculi. Methods from March 2015 to July 2016, 96 patients with complicated renal calculi were randomly divided into two groups with 48 cases in each group. The control group was treated with single-channel MPCNL pneumatic lithotripsy, and the observation group was treated with single-channel MPCNL pneumatic lithotripsy combined with holmium: YAG laser lithotripsy. All patients underwent plain urography, color Doppler urography, intravenous urography or CTU. before operation. There was no significant difference in age, sex, stone size, urine routine leukocyte positive rate and urine culture positive rate between the two groups. The data of stone clearance rate, operation time, postoperative hemoglobin change, postoperative infection rate, postoperative urine clearance time, complication rate, hospitalization time, hospitalization cost and so on in the two groups were statistically analyzed. Results the stone removal rate was 93.75% (45 / 48) in the observation group and 77.10% (37 / 48) in the control group, the difference was significant (P0.05). The operative time in the observation group (58.1 卤25.2min) was longer than that in the control group (46.8 卤20.5min) (P0.05). Compared with the control group, there was no significant difference in bleeding, postoperative infection and urine clearance time between the observation group and the control group (P0.05). There was no significant difference between the two groups before and after 30min, but at 1 h and 2 h after operation, the WBC levels were significantly higher than those before operation (P0.05). Preoperative urine routine leucocyte abnormality postoperative infection rate was high, with statistical significance (P0.05). The hospitalization cost of observation group and control group was increased (P0.05), but the length of hospitalization was not significantly prolonged (P0.05). Conclusion single-channel MPCNL pneumatic lithotripsy combined with ureterostomy ureteroscopic holmium: YAG laser lithotripsy is effective in the treatment of complicated renal calculi.
【学位授予单位】：新乡医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R699.2

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