微通道和标准通道PCNL治疗复杂性肾结石的比较

目的探讨与评价微通道和标准通道经皮肾镜碎石取石术（PCNL）两种方法治疗复杂性肾结石的安全性和临床疗效。方法我们采用标准通道（22F）和微通道（18F）PCNL治疗复杂性。肾结石49例，并记录碎石取石时间，结石取净率及手术并发症。结果49例患者均Ⅰ期成功建立经皮肾通道，标准通道组21例中，17例Ⅰ期碎石取石成功，4例行Ⅱ期碎石，平均碎石手术时间为（75±25）min。微通道组28例中，18例Ⅰ期手术成功，10例行Ⅱ期碎石，碎石时间为（92±31）min，两组比较有显著性差异（P〈0．05）；术后检测血红蛋白（Hb），标准通道组20例（20／21）Hb下降〈30g／L，微通道组26例（26／28）Hb下降〈30g／L，两组比较无显著性差异（P〉0．05）；标准通道组结石清除率85．7％（18／21），微通道组82．2％（23／28），两组比较无显著性差异（P〉0．05）。结论标准通道和微通道PCNL治疗复杂性。肾结石疗效确切，均具有损伤小、恢复快、结石清除率高，并发症少等优点，但采用标准通道能缩短取石时间，两者结合效果更好。

Nephrolithotomy for treatment of complex kidney calculi using standard and mini-percutaneous renal tract

Objective To investigate and evaluate the safety and efficacy of standard and mini-percutaneous renal tract to deal with complex kidney calculi. Methods A total of 49 cases suffering form complex kidney calculi underwent percutaneous nephrolithotomy （PCNL） using standard （F22） or mini-percutaneous （F18） renal tract. And the operation time of stone clearance, complication and stone free-rate were recorded and analyzed. Results All the cases were punctured successfully. Of the 49 cases, 21 cases were treated using F22 renal tract, and 28 cases using F18. The average time of stone clearance in F22 group （75±25）min was significantly longer than that in F18 group （92±31）min. The haemoglobin level of the patients were observed after operation, and the change of the level is similar in both groups （P〉0.05）. The stone free-rate have no remarkable difference between F22 group （85.7%）and F18 group（82.2%）. Conclusions The standard and mini-percutaneous renal tract appear to be minimally invasive safe and effective, producing quick recovery, less complication , and high stone-free rate for complex kidney calculi removal, but the operation time of stone clearance decreased remarkably using standard renal tract. If combined, a better result will be got.