第10～11肋间入路经皮肾镜碎石术治疗多发性肾结石疗效观察

目的 探讨B超引导下第10～11肋间入路经皮肾镜碎石术治疗多发性肾结石的临床效果.方法 选择多发性肾结石患者50例,其中观察组22例,采用第10～11肋间入路,对照组28例,采用第12肋下入路,均用气压弹道联合超声碎石,对两组手术时间、术中出血量、一次性结石清除率、并发症、术后住院时间进行比较.结果 与对照组相比,观察组一次性碎石成功率较高(分别为81.9％和78.6％),手术时间较长[分别为(97.65±9.78)min和(86.43±9.35 )min],术中出血量较多[分别为( 103.45±6.59) ml和(95.27±7.56)ml],气胸发生率较高(13.6％、0％),差异均有统计学意义(P＜0.05).结论 第10～11肋间入路经皮肾镜治疗多发性肾结石I期结石清除率较高,手术时间较长,出血量较多,有发生气胸的可能,但熟练掌握后可作为经皮肾镜技术的一种选择.

Effective observation on percutaneous nephrolithotripsy by approach through 10-11 intercostals for treating complex renal stones

Objective To evaluated the clinical effects of B-type ultrasound mediated percutaneous nephrolithotripsy(PCNL) by approach through 10-11 intercostals on the patients with complex renal stones.Methods 50 cases of complex renal stones were taken into the trial.22 cases in the observation group adopted the approach through 10-11 intercostals,while the other 28 cases in the control group were performed the approach through 12 intercostal.All the cases accepted PCNL associated by pneu matic and ultrasound lithotripsy.The blood loss,one-time stone-free rate,complication and stay time after operation were compared between the two groups.Results Compared with the control group,the one-time stone-free rate in the observation group was higher(81.9% vs.78.6%,P<0.05),the time of surgery was longer [(97.65±9.78) min vs.(86.43±9.35) min,P<0.05],pneumothorax probability was higher(13.6% vs.0%,P<0.05),and the blood loss was more [(103.45±6.59)ml vs.(95.27±7.56,P<0.05 ml].Conclusion PCNL by approach through 10-11 intercostal achieves higher stone-free rate,longer operation time and more intraoperative blood loss with pneumothorax probability,but which may be as an option of percutaneous nephroscopic technique after skillfully mastering.