开放性手术和PCNL在治疗鹿角形肾结石中的应用

目的探讨鹿角形肾结石的手术治疗方式，比较经皮肾穿刺碎石（Percutaneous nephrolithotomy，PCNL）与开放性手术的临床价值。方法回顾分析20例PCNL和15例肾切开取石及肾盏成形术的临床资料，比较两种术式在手术时间、术中出血量、结石清除情况、术后住院时间及并发症发生率等有无差异。结果术前两组对象在性别、年龄、结石大小、肾积水情况方面无明显差异（P〉0．05）；开放手术及PCNL组平均手术时间、平均出血量、术后住院时间分别为：（159.6±29．O）min和（321．9±112．4）min、（262．5±129．0）mL和（149．8±84．1）mL、（9．9±2．7）d和（14．1±3．8）d，差异均具有统计学意义（P〈0．01）；20例PCNL中一次取净结石5例，Ⅰ期结石取净率25％，二次取净结石11例，三次取净结石2例，四次取净结石2例。15例肾切开取石及肾盏成形术中全部一次取净结石，结石取净率100％，两组间有明显差异（P〈0．001）；术中并发症，PCNL组15％（3／20），开放手术组33．33％（5／15），无明显差异（P〉0．05）。结论鹿角形肾结石的手术方式应根据患者的病情及医院的实际情况慎重选择，对复杂性巨大鹿角肾结石较适合用开放性手术治疗。

Treatment of antler-like renal stone with percutaneous nephrolithotomy or open operation

Objective To compare and evaluate the clinical value between percutaneous nephrolithotomy （PCNL） and open operation in the treatment of antler-like renal stone. Methods The clinical data of 20 patients who underwent PCNL and 15 patients who underwent open operation were analyzed retrospectively. The differences in operating time, average bleeding volume during operation, stone clearance, postoperative hospital stay and complications of the two procedures were compared. Results There were no differences in the sex, age, stone size, and nephrohydrosis between the two groups （P〉 0.05）. The stones were removed completely in 5 patients （25%） in the PCNL treatment group and in all 15 patients （100%） treated with open surgery. The mean operation time, average bleeding volume during operation, postoperative hospital stay of the PCNL and surgery group were： （159.6±29.0）min vs. （321.9±112.4）min, （262.5±129.0）mL vs. （149.8±84.1）mL, and （9.9±2.7）d vs. （14.1±3.8）d, respectively. The differences between the two groups were significant （P〈0.01）. In the PCNL group, hemorrhage occurred in 3 cases and the complication rate was 15%. In the open surgery group, hemorrhage occurred in 3 cases and pleural injury occurred in 2 cases; the complication rate was 33.33%. The difference was not significant （P〉0.05）. Conclusion The choice to remove antler-like renal stone by PCNL or open operation should be cautious. The condition of both the patient and hospital should be considered. Open surgery should be the first choice of treatment for antler-like renal stones.