微通道经皮肾镜钬激光碎石术与标准通道气压弹道联合超声碎石术的疗效比较

目的比较B超引导下微通道经皮肾镜钬激光碎石术(mPCNL)与标准通道经皮肾镜气压弹道联合超声碎石术(标准通道PCNL)治疗复杂性肾结石的临床疗效。方法对78例复杂性肾结石患者分别行mPCNL(35例)和标准通道PCNL(43例)治疗,术后对2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 2组患者分别成功建立16F和24F经皮肾通道并一期行碎石术。mPCNL组手术时间明显长于标准通道PCNL组;一期结石清除率mPCNL组低于标准通道PCNL组,差异均具有统计学意义(P均<0.05)。mPCNL组术后出血明显需要输血治疗者有1例,标准通道PCNL组无输血病例;所有病例均未出现邻近脏器损伤,mPCNL组有1例经第11肋间穿刺肾上盏患者出现胸腔积液,经胸腔闭式引流后痊愈;标准通道PCNL组出现腹腔积液2例,经抽液、利尿后痊愈。mPCNL组术后体温>38.5℃1例。2组并发症差异无统计学意义(P>0.05)。结论 B超引导下mPCNL与标准通道PCNL治疗复杂性肾结石安全有效、并发症发生率低,标准通道PCNL联合应用EMS第4代气压弹道联合超声碎石清石系统碎石清石效率高,较mPCNL钬激光碎石明显有优势,值得推广。

Comparison of efficacy between mPCNL with holmium laser and EMS standard tract PCNL in the treatment of complex renal calculi under ultrasound guidance

Objective To compare the outcomes of the surgical treatment of complex renal calculi with minimally invasive percutaneous nephrolithotomy(mPCNL) and EMS percutaneous nephrolithotomy(standard tract PCNL) under ultrasound guidance.Methods A total of 78 patients with complex renal calculi were allocated to either mPCNL treatment group(mPCNL group,n=35) or EMS(swiss,the fourth generation) standard tract PCNL treatment group(standard tract PCNL group,n=43).The operative time,primary stone-free rate and operative complications in the two groups were compared.Results 16F and 24F percutaneous renal accesses were successfully established in mPCNL group and standard tract PCNL group respectively,and then the first lithotrity-lithiasis cleaning procedure was performed.The operation time in mPCNL group was longer than that in the standard tract PCNL group 〔(102±31) min vs(67±22) min,P<0.05〕.The primary stone-free rate in mPCNL group was lower than that in standard tract PCNL group(65.7% vs 88.4%,P<0.05).The postoperative bleeding that needed blood transfusion occurred in one patient of mPCNL group,and no bleeding case that needed blood transfusion occurred in standard tract PCNL group.No injuries of adjacent viscera occurred in all patients.In mPCNL group,pleural effusion occurred in one patient who underwent puncturing upper renal calyce through 11 intercostal place,and cured through closed drainage of pleural cavity.In standard tract PCNL group,abdominis hydrops occurred in two patients who were cured through the treatment of aspirating effusion and diuresis.The body temperature >38.5 ℃ occurred in one case of mPCNL group.There was no significant difference in operative complications in two groups(P>0.05).Conclusions Both the treatments of complex renal calculi with mPCNL and EMS(the fourth generation) standard tract PCNL under ultrasound guidance are similarly safe,but the standard tract PCNL has the superiority of higher primary stone-free rate and shorter operation time over the holmium Laser mPCNL.Therefore the standard tract PCNL merits propagation for treating complex renal calculi.