两种入路经皮肾镜取石术治疗复杂型肾下盏结石的疗效对比

 目的 比较两种不同穿刺入路经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗复杂型肾下盏结石的疗效。方法 回顾性分析武警新疆总队医院泌尿外科2015-10至 2020-10用PCNL治疗的258例复杂型肾下盏结石的病历资料。根据患者穿刺入路分成肾上盏组和肾下盏组,并从手术时间、一期结石完全清除率、术中术后并发症三个方面比较两种不同穿刺入路PCNL的疗效差异。结果 所有患者均成功一期建立通道,成功率为100%。结石清除率方面肾上盏组(85.92%)明显高于肾下盏组(59.62%),差异有统计学意义(P＜0.05);手术时间肾上盏组为(74.69±2.94)min,肾下盏组为(84.50±15.25)min;术后并发症发生率肾上盏组为6.31%,肾下盏组为32.69% ;血红蛋白下降肾上盏组为(13.10±0.60)g/L,肾下盏组为(14.60±0.30)g/L;上述指标肾上盏组明显低于肾下盏组,差异均有统计学意义(P＜0.05)。肾上盏组术中、术后大出血、感染发生率较肾下盏组低,且差异有统计学意义。结论 对复杂型肾下盏结石经肾上盏通道入路的PCNL,结石一次清除率高,出血少,手术时间短,安全有效,值得推广。

A comparison of two pathways of percutaneous nephrolithotomy in the treatment of complex lower calyceal calculi

Objective To compare the efficacy of two pathways of percutaneous nephrolithotomy (PCNL) in the treatment of complex lower calyceal calculi. Methods The clinical data on 258 cases of complicated lower calyceal calculi treated with PCNL between October 2015 and October 2020 in the Department of Urology at our hospital was retrospectively analyzed. According to the puncture pathway, the patients were divided into the upper calyx group and lower calyx group. The difference in efficacy between the two pathways of PCNL was studied in terms of duration of surgery,complete stone clearance rates and intraoperative and postoperative complications. Results All the patients had their access established in phase I. The stone clearance rate of upper calyces (85.92%) was significantly higher than that of lower calyces (59.62%). The duration of surgery was (74.69±2.94) min in the upper calyx group and (84.50±15.25) min in the lower calyx group. The incidence of postoperative complications was 6.31% in the upper calyx group and 32.69% in the lower calyx group. The decrease of hemoglobin was (13.10±0.60) g/L in the upper calyx group and (14.60±0.30) g/L in the lower calyx group.The difference was statistically significant (P<0.05). The incidence of bleeding and infections in the upper calyx group was significantly lower than in the lower calyces. Conclusions PCNL for complex lower calyceal calculi via the upper calyceal pathway is safe and effective with a high stone clearance rate, less bleeding and shorter duration of surgery.