EMS超声—气压弹道碎石与微通道钬激光碎石对复杂肾结石碎石117例疗效分析

Clinical safety and efficacy for complicated renal calculus therapy,comparing PCNL combined pneumatic ultrasound lithotripsy to mPCNL combined holmium laser lithotripsy,117 cases analysis

目的比较标准通道联合EMS超声-气压弹道碎石(EMS-PCNL)与微通道钬激光碎石(YA:G-mPCNL)两种方法对复杂肾结石碎石的疗效。方法回顾性分析2008年10月至2011年10月分别采用标准通道联合超声-气压弹道碎石及微通道联合钬激光碎石两种方式治疗的复杂肾结石117例,比较两种碎石方法分别对鹿角形结石和多发肾结石进行治疗的手术时间、Ⅰ期结石清除率、术后平均住院日及术中、术后并发症等。结果标准通道联合超声-气压弹道碎石术组手术时间较微通道钬激光碎石组明显缩短:鹿角形结石碎石时间分别(76±24.4)min和(146.6±32.1)min,P<0.05;多发结石碎石时间分别为(63±19.3)min和(117±37.5)min,P<0.05。两种方法的Ⅰ期结石清除率无统计学差异(鹿角形分别为88.2%和72.7%,P>0.05;多发结石分别为84.1%和81.3%,P>0.05),术中、术后并发症等均无明显差异。结论标准通道联合超声-气压弹道碎石的手术时间短,术后恢复快,有较高的有效性和安全性,为复杂肾结石首选治疗方法,适合临床推广。

Objective To evaluate the clinical efficacy of two techniques for the treatment of complicated renal calculus ,comparing standard percutaneous nephrolithotomy（PCNL） combined pneumatic ultrasound lithotripsy to minimally invasive percutaneous nephrolithotomy （mini-PCNL, mPCNL）combined holmium laser lithotripsy. Methods Including antlers shape stones and multiple stones, 145 lateral renal stone burden, 117 inpatient treated with PCNL or mPCNL during October 2008 to October 2011 were retrospectively analyzed. The operative duration, stone-free rate, average days of postoperative hospitalization, intraoperative and postoperative complications were contrasted between the standard PCNL combined pneumatic ultrasound lithotripsy group and mPCNL combined holmium laser lithotripsy group. Results The operative duration for antler shape stones was （ 76 ± 24.4 ） min in standard PCNL group and （146. 6 ± 32. 1 ）rain in mPCNL group, the operative duration for multiple stones was（63 ±19. 3 ）min and（ 117± 37.5 ）min, statistical significance were found between them both. The clearance rate of antlers shape stones in PCNL and mPCNL group was 88. 2% and 72. 7% , respectively. And the clearance rate of multiple stones was 84. 1% and 81.3%, respectively. No significant difference was found between the two groups. The intraoperative or postoperative complications between them had no difference either. Conclusions The standard PCNL combined pneumatic and ultrasound lithotripsy have the advantages of less operative duration,faster recovery, higher safety and efficacy. This treatment would be the first choice for the therapy of complicated renal calculus.