不同手术时机经皮肾镜多通道治疗复杂性肾结石的对比研究

Contrasting study of multi-tract percutaneous nephrolithotomy for complicated renal calculi in different operative stages

目的 探讨在不同手术时机采用多通道经皮肾镜技术治疗复杂性肾结石的临床疗效.方法 超声引导下多通道经皮肾镜治疗复杂性肾结石213例,将患者随机分二组：91例Ⅰ期单通道、Ⅱ期多通道碎石者为分期手术组,122例Ⅰ期建立多通道碎石者为同期手术组.将二组患者的临床资料进行对比.结果 213例手术均成功.分期手术组：平均手术时间106min,术中平均出血155ml,术后迟发出血4例,2例输血,1例需介入栓塞治疗,术后发热18例,平均住院18d,清石率74.7%（68/91）.同期手术组：平均手术时间65min,术中平均出血135ml,术后迟发出血5例,3例输血,1例介入栓塞治疗,术后发热19例,平均住院10d,清石率75.4%（92/122）.两组间的出血量、输血率、术后发热、清石率比较差异无统计学意义（P〉0.05）,同期手术组手术时间和住院时间均低于分期手术组（P〈0.05）.结论 超声引导下多通道经皮肾镜治疗复杂性肾结石清石率高,同期多通道技术的手术时间短,住院时间减少,且不增加大出血和感染发生率,值得临床采用.

Objective To evaluate the clinical therapeutic effect of multi-tract standard percuta- neous nephrolithotomy（PCNL） in the treatment of complicated renal calculi in different operative stages. Methods The clinical data of 213 patients with complicated renal calculi who underwent multi-tract PC-NL with ultrasound guidance were analyzed. Those patients were randomly divided into two groups ：91 ca-ses treated in two different stages（ staging group）, and 122 cases treated in a single session（one-stage group）. Results All of the 213 cases were operated successfully. In staging group, median operative time was 106 nlin; Mean bleeding volume was 155 ml; Tardus hemorrhage occurred in 4 cases,in which 2 nee-ded blood transfusion and 1 required selective renal artery embolization; 18 cases had a post-operative fe-ver; Median hospital stay was 18 days;Stone clearance rate was 74.7% （68/91）. In one-stage group,me-dian operative time was 65 min; Mean bleeding volume was 135 ml; Tardus hemorrhage occurred in 5 ca-ses, in which 3 needed blood transfusion and 1 required renal artery embolization; 20 cases had a post-op-erative fever; Median hospital stay was 10 days; Stone clearance rate was 75.4% （92/122）. There were no significant differences in the rates of bleeding, blood transfusion, post-operative fever or stone clearance between the two groups（ P 〉 0.05 ）, but the one-stage group had shorter operative time and hospital stay than that of staging group （ P 〈 0.05 ）. Conclusion The method of multi-tract PCNL under ultrasound guidance has a high stone clearance rate for the management of complicated renal calculi. Muhi-tract PCNL in single session has reduced operative time and hospital stay without increased incidence rate of bleeding or infection,which deserves a wider application.