微创经皮肾镜超声碎石清石术与钬激光碎石术治疗巨大肾结石的疗效比较

目的：比较微创经皮肾镜下新型超声碎石清石术与钬激光碎石术治疗巨大肾结石的疗效和安全性。方法：315例巨大肾结石(结石最大径均大于3 cm)按照两种碎石方法开展的时间先后顺序分为两组,超声碎石清石术组260例,钬激光碎石术组55例,比较两种碎石方法在手术碎石时间、结石清净率、术后平均血红蛋白下降发生率、手术后住院时间等指标的差异。结果：超声碎石组平均碎石取石时间(56 min)明显低于激光组(82 min)(P<0.01) ; 超声碎石组Ⅰ期手术结石清净率为81.5%（212/260）,Ⅱ期手术后总清净率为87.7%（228/260）;残留结石中有15例需体外震波碎石治疗;激光组Ⅰ期手术结石清净率为65.5%（36/55）,Ⅱ期手术后总清净率为76.4%（42/55）;残留结石中有10例需体外震波碎石治疗;两组Ⅰ期手术结石清净率比较差异有显著性(P<0.01) 。钬激光组术后平均住院时间为8 d,超声组平均6 d,两组比较差异有显著性(P<0.05)。结论：微创经皮肾镜治疗复杂巨大肾结石,采用超声碎石清石术与激光碎石术比较,具有手术时间短、术中出血少、清石效率高等优点,尤其在治疗肾巨大铸形结石时,超声碎石清石术是理想选择。

Curative effect of complicated renal calculi:comparison between holmium laser lithotripsy and ultrasonic lithotripsy

Objective To compare the efficacy and safety of minimally invasive percutaneous nephrosomy for complicated renal calculi between holimium laser lithotripsy and ultrasonic lithotripsy.Methods 315 cases were analyzed including the average time of lithotripsy,the rate of stone completely expelled and the rate of complications.Results The average time of lithotripsy in ultrasound group(56 min)was lower than that in laser group(82 min)(P<0.01);the clearnce rate of stone at stage Ⅰ operation in ultrasound group(81.5%)was higher than that in laser group(65.5%)(P<0.01);the average hospitalization time in ultrasound group(6 d) was less than that in laser group(8 d)(P<0.05);the incidence of hemoglobin decrease in ultrasound group(5.0%) was lower than that in laser group(12.7%)(P<0.05).Conclusion Percutaneous nephrostomy with ultrasonic lithotripter for complicated renal calculi has the advautages of mini-invasion,less operative duration,radid recovery,safety and very effective and faster clearance compared with laser lithotripsy.