三种经皮肾穿刺取石术治疗上尿路结石对照分析

目的：比较李氏肾镜与标准经皮肾镜及微创经皮肾输尿管镜治疗上尿路结石的有效性与安全性,提高上尿路结石的治疗水平.方法：2005年1月～2009年1月,三种经皮肾穿刺取石术治疗上尿路结石132例,其中包括肾结石87例（包括肾脏单发及多发结石56例,鹿角型结石31例）,输尿管上段结石45例.标准经皮肾镜取石术34例,年龄34～78岁,平均57岁;结石大小2.3～5.8 cm,平均3.5 cm;鹿角型结石14例.微创经皮肾输尿管镜取石术52例,年龄31～77岁,平均51岁;结石大小2.1～5.0 cm,平均3.3 cm;鹿角型结石8例.经皮李氏肾镜取石术46例,年龄29～81岁,平均55岁;结石大小2.0～5.5 cm,平均3.0 cm;鹿角型结石9例.对三组患者手术时间、留置造瘘管时间、I期结石清除率及手术出血进行比较.结果：李氏肾镜治疗输尿管上端结石（L4）手术时间（56±5）min,治疗上尿路结石I期手术清除率为80.43%,出血量为（156±38）ml,输血率2.17%,与标准经皮肾镜及微创经皮肾输尿管镜比较,差异均有统计学意义（P＜0.05）.对李氏肾镜治疗6例肾盂单发结石患者实行＂无管化＂,均恢复较好,无一例发生出血、漏尿及感染.结论：李氏肾镜在微造瘘经皮肾手术中较标准肾镜和输尿管镜代肾镜具有操作更简化、手术效率更高、剩余结石更少、并发症减少等优点.

Comparative Analysis of Three Treatments of Upper Urinary Calculi with Percutaneous Nephrolithotomy

Objective：To compare the efficacy and safety of Leers nephroscope, standard Percutaneous nephrolithotomy （PCNL） and minimally invasive PCNL, and improve the level of treatment in Upper urinary calculi. Methods：From January 2005 to January 2009 ,three treatments of upper urinary calculi with PCNL were performed in 132 patients,include 87 cases of kidney calculi （There were 56 renal units with singer or multi- kidney pelvic and calyceal calculi, 31 renal units with staghorn calculi） and 45 renal units with upper ureteral calculi. Standard percutaneous nephrolithotomy lithotomy 34 cases, the mean age was 57 years （range 34-78 years） ; the average stone diameter was 3.5 cm（range 2.3-5.8 cm） , renal units with staghorn calculi 14 case. Minimally invasive percutaneous nephrolithotomy PCNL in 52 cases,the mean age was51（range 31-77 years）, the average stone diameter was 3.3 cm（range 2.1-5.0 cm） , renal units with staghorn calculi 8 case. Lee＇s nephroscope , standard PCNL and minimally invasive PCNL were performed in 46 ,the mean age was 55 years（range 29-81 years） ,the average stone diameter was 3.0 cm（range 2.0-5.5 cm） ,and there were 9 staghorn calculi patients . Clinical date including the time of operation and nephrostomy tube for drainage, phase 1 stone-free rate and blood loss volume of operation were compared. Results：The operative time for upper ureteral calculi was（564-5）min, phase 1 stone-flee rate for Upper urinary calculi was 80.43%, blood loss volume of operation was（156±38）ml and the rate of tansfusion was 2. 17% in Lee＇s nephroscope for Upper urinary calculi with PCNL, which had significant difference with another two treatments of upper urinary calculi with PCNL. 6 patients of renal units with singer kidney pelvic calculi had no blooding, urinary leakage and fever or infection following Tubeless Lee＇s nephroscope in PCNL. Conclusions： Lee＇s nephroscope in PCNL can improve the efficiency, accelerate the speed, reduce the residual stones and the complications of operation.