微通道经皮肾镜碎石术与标准通道经皮肾镜碎石术治疗肾结石的比较

Comparison of curative effect of renal stone treatment between PCNL and mPCNL

目的探讨并比较肾结石患者行微通道经皮肾镜碎石术(mPCNL)与标准通道经皮肾镜碎石术(PCNL)的安全性及有效性。方法对120例行微通道经皮肾造瘘Wolf输尿管镜超声碎石和306例行经皮肾造瘘Wolf肾镜超声碎石的肾结石患者的临床资料进行回顾性分析。结果 120例行mPCNL的患者中88例(73.3%)成功Ⅰ期取净结石,32例术后复查发现残石,其中29例术后行体外冲击波碎石术(ESWL)术,术后排出残石,3例Ⅱ期手术,并成功清石。5例(4.1%)患者术中出血较多,5例术后均经抗感染、止血等对症治疗后好转。行PCNL的患者其中262例成功Ⅰ期取净结石(85.6%),40例术后行体外冲击波碎石术,术后复查未查见残石,4例行Ⅱ期手术,并成功清石。12例(3.9%)患者术后出血较多,8例术后经抗感染、止血等对症治疗后好转,3例采用选择性肾动脉栓塞治疗控制了出血,1例急诊行肾脏切除术。结论 mPCNL组与PCNL组治疗肾结石在术后出血率上的差异无统计学意义,Ⅰ期清石率上的差异有统计学意义,且PCNL组高于mPCNL组。

Objective To investigate and compare the efficacy and safety of standard and mini-percutaneous renal tract in treatment of renal calculi.Methods 120 patients treated by minimally invasive percutaneous nephrolithotomy（mPCNL） and 306 patients treated by percutaneous nephrolithotomy（PCNL） were analyzed retrospectively.Results No residual stone fragment in phaseⅠlithotripsy of 88 patients treated with mPCNL,stone free rate was 73.3%.Residual stone fragment was found in 32 patients,29 patients adjuvant ESWL and 3 patients received phase Ⅱ mPCNL,with no residual stone fragment after above treatment.There was serious bleeding in 5 patients（4.1%） after lithotripsy,5 patients all controlled the bleeding by treatment of anti-infection and hemostatic.No residual stone fragment in phaseⅠlithotripsy of 262 patients treated with PCNL,stone free rate was 85.6%.Residual stone fragment was found in 44 patients,40 patients adjuvant ESWL and 4 patients received phase II PCNL,with no residual stone fragment after above treatment.There was serious bleeding in 12 patients（3.9%） after lithotripsy,8 patients controlled the bleeding by the treatment of anti-infection and hemostatic.3 patients controlled the bleeding by the treatment of highly selective renal artery embolization under digital substraction angiography（DSA）,1 patient resection of kidneys by emergency surgery.Conclusion There is no significant difference in the rate of hemorrhage between patients treated with mPCNL and those treated with PCNL（P﹥0.01）.While significant difference was found in the stone free rate of phase Ⅰlithotripsy（P﹤0.01）.And the stone free rate of PCNL group is higher than that of mPCNL group.