微创肾镜与输尿管镜在微创经皮肾穿刺取石术治疗上尿路结石中的对比研究

目的：比较微创肾镜与输尿管镜在微创经皮肾穿刺取石术（mPCNL）治疗上尿路结石中的有效性及安全性。方法：回顾性分析2009年5月～2010年4月由同一医师应用mPCNL（一期单通道）治疗213例上尿路结石患者的临床资料：微创肾镜组125例，结石平均直径3．4cm，鹿角形结石84例，肾盏多发结石29例，肾盂结石及输尿管上段结石12例；输尿管镜组88例，结石平均直径3．2cm，鹿角形结石49例，肾盏多发结石17例，肾盂结石及输尿管上段结石22例。对比分析两组的手术时间、结石清除率、手术出血量、术中灌注液量及手术并发症。结果：所有患者手术均获成功，无严重手术并发症发生。两组结石大小差异无统计学意义，微创肾镜组的手术时间及手术出血量分别为（32±11）min及（65±18）ml，明显低于输尿管镜组（48±15）min和（84士23）rnl，而微创。肾镜组的术中灌注液量高于输尿管镜组，分别为（15．0±2．6）L及（u．0±1．4）L。两组结石清除率及手术并发症差异无统计学意义。结论：微刨肾镜是一种新型、安全、有效的内镜设备，能明显提高手术效率，值得临床推广。

A Comparative Study of Efficacy and Safety of Mini Nephroscope and Semirigid Ureteroscope in Minimally Invasive Percutaneous Nephrolithotomy

Objective： To compare the efficacy and safety of mini nephroscope and semirigid ureteroscope in minimally invasive percutaneous nephrolithotomy （mPCNL） in upper urinary tract calculi. Methods： From May 2009 to April 2010,213 patients with upper urinary tract calculi were treated with mPCNL by the same surgeons. In these patients, 125 cases were treated with mini nephroscope and others with semirigid ureteroscope. The average stone diameter was 3.4 cm and 3.2 cm respectively. Clinical data including operative time, stone--free rate, blood loss and complication were compared. Results： All operations were successful and no major complications were noted in all patients. As compared to the semirigid ureteroscope group, the mini nephroscope group had a significant shorter operation tirne （32±11 ） minutes vs. （48±15） minutes, P〈0. 05] and a less blood loss 65± 18） ml vs. （84±23）ml,P〈O. 05] ,but the volunm of perfution liquied was larger in mini nephroscope group（15.0± 2.6）L vs. （11.0± 1.4）L,P〈0. 05]. No significant difference was detected in the rate of stone-free rate and complication between the two groups. Conclusions： As compared to the semirigid ureteroscope, the mini nephroscope was a more safe and effective endoscope in treat upper urinary tract calculi in mPCNL.