微创经皮肾镜取石术与标准通道经皮肾镜取石术的疗效比较

目的:比较微创经皮肾取石术(MPCNL)与标准通道经皮肾镜气压弹道联合超声碎石术治疗肾结石的临床疗效。方法:对125例肾结石患者分别行MPCNL(69例)和标准通道PCNL(56例)治疗,术后对两组患者的手术时间、一期结石清除率和手术并发症等指标进行比较分析。结果:两组患者分别成功建立16F和22F经皮肾通道并一期行碎石术。MPCNL组手术时间长于标准通道PCNL组;单纯肾盂结石患者一期结石清除率低于标准通道PCNL组,而肾盏多发性结石患者一期结石清除率则高于标准通道PCNL组,以上差异均具有统计学意义(P<0.05)。两组鹿角型结石患者一期结石清除率比较差异无统计学意义(P>0.05)。两组术中或术后出血明显需要输血治疗者分别为1例和3例,术后发热分别为10例和5例,差异均无统计学意义(P>0.05)。分别比较两组伴有肾功能不全患者术前及术后1月血肌酐及血尿素氮水平,差异均无显著性(P>0.05)。比较两组术后肾功能改善、稳定和恶化人数,差异均无统计学意义(P>0.05)。结论:MPCNL与标准通道PCNL并发症发生率低,对伴有肾功能不全结石患者术后近期肾功能均无明显影响。两种手术方式各有特点,标准通道PCNL联合应用EMS三代碎石清石系统碎石效率高,适合处理较大的肾盂结石;MPCNL碎石效率较低,但治疗肾盏多发性结石较标准通道PCNL有优势。

Comparison of Clinical Effect Between MPCNL and PCNL in the Treatment for Renal Calculi

Objective:To compare the outcomes of the surgical treatment of renal calculi with minimally invasive percutaneous nephrolithotomy (MPCNL) and percutaneous nephrolithotomy (PCNL). Methods:A total of 125 patients with renal calculi were assigned to undergo either MPCNL or PCNL surgery. Clinical data including operation time,stone-free rate,and complications were compared. Results:16F and 22F percutaneous renal access were successfully established in MPCNL and PCNL group respectively. The MPCNL group had a longer operation time than the PCNL group. One-stage stone-free rate for simple renal pelvis stone was significantly lower in the MPCNL group than in the PCNL group. However,the rate for multiple stones was significantly higher in the MPCNL group than in the PCNL group (P<0.05). There was no statistical difference in the one-stage stone-free rate for staghorn stone between the two groups (P>0.05). One patients in MPCNL group and three patients in PCNL group had blood transfusion intraoperatively or postoperatively,while 10 and 5 patients respectively in the two groups had postoperative fever (both P>0.05). Pre-and post-operation serum creatinine and blood urea nitrogen level in patients with renal insufficiency was not statistical different between the two groups respectively. And there was no statistically difference in the cases of renal function improvement,stability,and deterioration between the two groups. Conclusion:Standard tract PCNL had the same security as MPCNL in the treatment of kidney stones. The two operative methods had low incidence of complications and could preserve renal function efficaciously. Standard tract PCNL would significantly reduce the operation-time and may be suitable for large renal stone,while MPCNL may has advantages in the treatment for small renal pelvis stone and renal calyx stone.