经皮肾镜双导管超声碎石清石术与钬激光碎石术在治疗巨大肾结石的对比研究

目的对比分析经皮肾镜双导管超声碎石清石术与钬激光碎石术在治疗巨大肾结石的临床疗效、安全性。方法选取我院2012年6月至2014年6月收治的80例巨大型肾结石(d≥3 cm)患者,根据碎石方法的不同将患者分为两组:双导管超声组40例,采用双导管超声碎石清石术治疗肾结石;钬激光组40例,采用钬激光碎石术治疗肾结石。比较分析两组患者在碎石时间、结石清除率、术后血红蛋白水平及住院时间等指标的差异。结果双导管超声组患者平均碎石时间和住院时间均明显短于钬激光组,差异具有统计学意义(P<0.05);双导管超声组患者Ⅰ期、Ⅱ期的肾结石清除率明显高于钬激光组(P<0.05);双导管超声组患者术后血红蛋白下降发生率明显低于钬激光组,差异具有统计学意义(P<0.05);两组患者迟发性肾出血、肾功能异常及肾功能衰竭的发生率无明显性差异(P>0.05)。结论经皮肾镜双导管超声碎石清石术作为一种微创治疗手段,应用于巨大肾结石的治疗,手术时间短,结石清除率高,术中出血少,可作为巨大肾结石的常用治疗手段在临床中推广。

Comparative Study of Percutaneous Nephroscope Ultrasonic Lithotripsy with Double Catheter and Holmium Laser Lithotripsy in the Treatment of Complicated Renal Calculi

Objective To compare and analyze the clinical effect and safety of percutaneous nephroscope ultrasonic lithotripsy with double catheter and holmium laser lithotripsy in the treatment of complicated renal calculi. Methods 80 patients with complicated renal calculi （d ≥ 3 cm） in our hospital from June 2012 to June 2014 were selected and divided into the double catheter ultrasound group and the holmium laser group according to the lithotripsy methods, with 40 cases in each group. The differences of lithotripsy time, stone clearance rate, postoperative hemoglobin level and length of hospital stay between two groups were compared. Results The mean time of lithotripsy and length of hospital stay of double catheter ultrasound group were significantly lower than those of holmium laser group （both P 〈0.05）. The one-staged stone clearance rate and two-staged stone clearance rate of double catheter ultrasound group were significantly higher than those of holmium laser group respectively （both P 〈0.05）. The incidence of decline of postoperative hemoglobin level of double catheter ultrasound group was significantly lower than that of holmium laser group （P 〈0.05）. There were no statistical differences between two lithotripsy methods in the incidences of delayed renal hemorrhage, renal dysfunction and renal failure （P 〉0.05）. Conclusions As a minimally invasive therapy, percutaneous nephroscope ultrasonic lithotripsy with double catheter has the advantages of shorter operative time, higher stone clearance rate and less blood loss for the treatment of complicated renal calculi, which is worthy of promotion in clinic.