微创经皮肾穿刺取石与开放性手术治疗肾结石的疗效比较

Comparison of Therapeutic Efficacy Between Minimally Invasive Percutaneous Nephrolithotomy and Open Surgery for Nephrolithiasis

【目的】比较微创经皮肾穿刺取石与开放性手术治疗肾结石的疗效 ,并探讨微创经皮肾穿刺取石术操作要点。【方法】对 12 4例肾结石微创经皮肾穿刺取石 (微创组 )临床资料进行回顾性分析 ,并与开放性手术 (开放组 ) 118例进行比较。【结果】微创组手术时间为 (70 .1± 14 .8)min ,术中出血量 (47± 33.6 )ml、术后用止痛药 2 6例、术后发热 4 2例、下床活动时间 (2 2± 4 .0 )h ,住院时间 (5 .2± 1.2 )d均分别显著少于开放组的(10 7± 30 .7)min ,(2 12 .2± 70 .3)ml,118例 ,94例 ,(5 4± 5 2 .2 )h ,(13.6± 2 .9)d ,P均 <0 .0 1,而结石取净率显著高于开放组 (93.5 5 %vs 6 1.86 % ,P <0 .0 1)。【结论】微创经皮肾穿刺取石术具有创伤小 ,出血少 ,结石取净率高 ,患者康复快 ,疼痛轻等优点 ,是一种治疗肾结石有效的方法。

ObjectiveTo compare the therapeutic efficacy of minimally invasive percutaneous nephrolithotomy(MIPN) with that of open surgery for nephrolithiasis(NL) and investigate the key points of manipulation in MIPN.Clinical data of 124 NL patients treated by MIPN (Minimally Invasive Group) were retrospectively reviewed and compared with those of 118 NL patients subjected to open surgery (Open Group).In minimally invasive group, the operative time [(70±14.8)]min, blood loss during operation [(47± 33.6 )]ml, number of cases required for postoperative analgesics(26cases), number of cases with postoperative pyrexia (42cases),the time needed for starting ambulation [(22±4.0)]h and the time of hospitalization [(5.2±1.2)]d were all significantly less than those in the open group [(107±30.7)]min, (212.2±70.3) ml, 124 cases, 94 cases, (54±52.2) h and (13.6±2.9) d, respectively,all P<0.01]. But the rate of getting stone-free in the former group was markedly higher than that in the latter(93.55% vs 61.86%,P<0.01).[Conclusion]MIPN has the advantages of less trauma, less bleeding, high rate of getting stone-free ,rapid recovery and slight pain. Thus it is a more effective method for the treatment of NL.