十年来复杂性肾结石治疗方法的演变和比较

The evolutions and comparions of treatments of complex renal calcul in the last decade

目的探讨复杂性肾结石的治疗方法。方法分析比较近十年来采用手术取石、体外冲击波碎石(ESWL)和微创经皮肾造瘘碎石取石术(MPCNL)治疗过程中的几项指标和效果。结果本组病例的治疗方法先由以手术取石为主,逐渐向置管后ESWL,再向MPCNL治疗为主转变。手术取石的排石率和排石时间最佳,但患者的创伤和痛苦最大,ESWL治疗的排石时间最长,MPCNL治疗的各项指标比较均居中,但综合比较效果稍优。结论对复杂性肾结石的治疗随着设备条件更新应逐步改变治疗观念,目前应首先考虑MPCNL或联合治疗,对结石巨大或合并有肾结构异常需手术处理时可开放手术取石,对结石不太大或密度不高,预计ESWL治疗次数在3次以内的,置管或直接ESWL治疗仍是较佳选择。

Objectives To explore the methods of therapy for complex renal calculi. Methods The effect and some data of the therapy for complex renal calculi with open surgery, ESWL and MPCNL in the last decade were analyzed and compared. Results Some evolutions of the therapy had taken place gradually in the last decade. In the earlier time the therapies of these cases were open surgery mainly. Subsequently it was ESWL after placement of catheter. Recently MPCNL was the main methods of the therapy. The rate and time of the lithagogue were the best in the open surgery, but the patients suffered the most trauma and pain. The lithagogue time was the longest in ESWL. All data in MPCNL were median, but the effect was a little better than other methods. Conclusions The concept of the therapy for complex renal calculi should be changed along with changes of the equipment gradually. Now MPCNL or combined therapy is the first choice. It may be necessary for open surgery, if the stone is huge or in kidney with structural abnomalities. It is still a better choice for ESWL, if the stone is not too large,of low density to be curedor about three times.