经皮肾镜取石术在高危肾结石患者中的安全性研究

目的探讨经皮肾镜取石术(PCNL)治疗高危肾结石患者的安全性和有效性。方法根据术前美国麻醉医师协会(ASA)评分,将226例行经皮肾镜取石术肾结石患者分为高危组(ASA～Ⅲ或Ⅳ)(61例)和低危组(ASA～Ⅱ或Ⅰ)(165例),所有患者均行标准通道(22F)PCNL钬激光碎石术。记录并比较两组手术时间、麻醉时间、术后住院时间、术中出血量、结石取净率、结石成分及手术并发症。结果两组患者在平均年龄(53.4±14.7岁vs51.6±16.3岁,P0.05)和体重指数(29.1±5.2vs29.9±4.7,P0.05)方面无显著统计学差异。高危组和低危组分别接受73次和184次PCNL手术。高危组和低危组在平均合并疾病数量之间有显著统计学差异(4.9±1.8vs1.6±0.7,P0.05)。两组在结石总体积之间无显著性差异(3.16±1.21cm3vs3.25±1.34cm3,P0.05)。高危组和低危组在平均麻醉时间(128±34minvs96±25min,P0.05)和平均术后住院天数(8.3±3.5dvs6.1±2.7d,P0.05)有显著性差异,但在平均失血量(146±28mlvs137±33ml,P0.05),并发症率(19.7%vs17%,P0.05)和手术时间(73±26minvs69±28min,P0.05)无显著性差异。高危组和低危组结石清除率分别为78.2%和93.8%,具有显著统计学差异(P0.05)。结论经皮肾镜取石术可以同样安全有效地治疗高危肾结石患者。

Percutaneous nephrolithotomy performed in the low- and high-risk patients with kidney stones: A retrospective study

Objective To explore whether percutaneous nephrolithotomy （PCNL） can be safely performed in the high-risk patients with kidney stones. Methods A total of 226 patients with kidney stones who underwent 257 consecutive PCNL from July 2007 to May 2009 were enrolled in this study. According to preoperative American Society of Anesthesiologist （ASA） scores, patients were divided into a high-risk group with ASA Ⅲ or Ⅳ （n= 61） and a low-risk group with ASA If or less （n= 165）, and all patients underwent PCNL with holmium laser through standard （22 F） nephrostomy tracts. Operative time, anesthesia time, length of hospital stay, blood loss, stone-free rate, stone composition and surgical complications were recorded and compared between two groups. Results There were no significant differences in age （53.4±14.7 vs 51.6±16.3 years, P〉0.05） and body mass index （29.1±5.2 vs 29.9±4.7, P〉0.05） between two groups. A total of 73 and 184 PCNL procedures were performed in the high-and tow-risk groups, respectively. The high-risk group had significantly more comorbidities than the low-risk group （4.9±1.8 vs 1.6±0.7, P〈0.05）. No significant difference was found in the mean cumulative stone size between two groups （3.16±1.21 cm3 vs 3.25±1.34 cm3, P〉0.05）. However, significant differences in the mean anesthesia time （128-＋34 min vs 96-＋25 min, P〈0.05） and mean duration of postoperative hospital stay （8.3±3.5 d vs 6.1±2.7 d, P〈0.05） were observed, while no significant differences in estimated blood loss （146±28 ml vs 137±33 ml, P〉0.05）, overall complication rate （19.7% vs 17%,P〉0.05） and mean operative time （73±26 min vs 69±28 min, P〉0.05） were found between two groups. The 78.2% stone-free rate in the high-risk group was significantly lower than 93.8% in the low risk group （P〈0.05）. Conclusion PCNL can be safely performed in the high-risk patients with kidney stones.