微创经皮肾镜取石术对高龄肾结石伴有轻度肾积水患者的疗效及安全性研究

目的 探究高龄肾结石伴轻度积水患者采用微创经皮肾镜取石术(MPCNL)治疗的疗效及安全性.方法 以2012年12月至2014年12月在本院治疗的78例高龄肾结石伴轻度积水患者为研究对象,依据随机数字表法划分为两组,对照组39例,行传统开放切开取石术治疗;观察组39例,行MPCNL治疗,比较两组相关临床治疗指标的变化.结果 ①手术情况:观察组患者的手术切口、术中出血量、手术时间均较对照组显著减少,差异有统计学意义(P＜ 0.05);②结石及积水情况:观察组总结石清除率及积水好转率均显著高于对照组,差异有统计学意义(P＜0.05);③肾功能:治疗前后,两组的Cr、β-MG、eGFR及RBP等肾功能指标比较差异无统计学意义(P＞0.05);④术后并发症:观察组术后并发症发生率(10.3％)显著低于对照组(33.3％),差异有统计学意义(P＜0.05);⑤复发情况:术后平均随访(11.3±2.5)个月,观察组失访3例,对照组失访4例,观察组肾结石复发率(2.6％)显著低于对照组(17.9％),差异有统计学意义(P＜0.05).结论 高龄肾结石伴轻度积水患者采用MPCNL治疗优势明显,有助于结石清除及积水好转,且减少术后并发症及复发,值得推广应用.

Clinical efficacy and safety of minimally invasive percutaneous lithotripsy in the treatment of elderly patients with renal calculi and mild hydronephrosis

Objective To explore the efficacy and safety of minimally invasive percutaneous lithotripsy (MPCNL) in the treatment of elderly patients with renal calculi and mild hydronephrosis.Methods 78 elderly patients with renal calculi and mild hydronephrosis in our hospital from December 2012 to December 2014 were selected as the research object,and divided into two groups according to the random number table method.39cases in control group were treated by traditional open nephrolithotomy,while 39 cases in observation group were treated by MPCNL.The clinical indicators of two groups were compared.Results ① The operation situation:the surgical incision,the amount of bleeding,the operation time of observation group were significantly less than those of control group,with statistically significant differences (P＜0.05);② stone and hydronephrosis situation:the total stone clearance rate and hydronephrosis improvement rate of observation group were significantly higher than those of control group,with statistically significant differences (P＜0.05);③ renal function:before and after treatment,there were no statistically significant differences in Cr,β-MG,eGFR,RBP,and other indicators of renal function between two groups (P＞0.05);④ postoperative complications:the incidence of postoperative complications in observation group was significantly lower than that in control group,with statistically significant difference (P＜0.05);⑤ recurrence:during postoperative follow-up average (11.3±2.5) months],observation group lost 3 cases,control group lost 4 cases,the recurrence rate of observation group was significantly lower than that of control group,with statistically significant difference (P＜0.05).Conclusion MPCNL in the treatment of elderly patients with renal calculi and mild hydronephrosis has obvious advantages,which is helpful to stone removal and the improvement of hydronephrosis,and can reduce postoperative complications and recurrence,it is worth popularizing.