不同成分上尿路结石行经皮肾镜取石术的疗效和安全性

Efficacy and safety of percutaneous nephrolithotomy for stones in upper urinary tract with different composition

目的:比较不同成分上尿路结石行经皮肾镜取石术的疗效和安全性。方法:回顾性分析2009年4月～2010年11月完成的190例经皮肾镜取石术患者的临床资料:按照术后结石成分分析结果分为草酸盐结石、尿酸盐结石及磷酸盐结石三组,比较三组结石负荷、手术时间、清石率、手术前后血红蛋白(Hb)水平变化及发热等指标的差异。结果:三组结石体积分别为草酸盐组(10.07±25.60)cm3,尿酸盐组(10.91±11.38)cm3,磷酸盐组(19.19±56.16)cm3,差异无统计学意义(P=0.584)。手术时间分别为草酸盐组(76.2±38.9)min,尿酸盐组(90.4±46.8)min,磷酸盐组(76.6±37.0)min,差异无统计学意义(P=0.155)。清石率分别为草酸盐组75.0%,尿酸盐组68.3%,磷酸盐组63.3%,差异无统计学意义(P=0.316)。术后发热病例数分别为草酸盐组30例,尿酸盐组15例,磷酸盐组17例,差异无统计学意义(P=0.740)。手术前后Hb降低值分别为草酸盐组(12.6±11.1)g/L,尿酸盐组(12.2±11.2)g/L,磷酸盐组(10.2±12.1)g/L,差异无统计学意义(P=0.469)。草酸盐组4例输血,尿酸盐组1例输血,磷酸盐组5例输血。结论:草酸盐结石、尿酸盐结石及磷酸盐结石行经皮肾镜取石术的手术疗效相似,并发症发生率也相似。

Objective：To compare the efficacy and safety of percutaneous nephrolithotomy（PCNL） for stones in upper urinary tract with different composition. Method： The clinical data of 190 patients underwent PCNL between April 2009 and November 2010 were retrospectively reviewed. According to the postoperative stone composition a- nalysis result, the patients were divided into 3 groups （oxalate salt group, uric acid salt group and phosphate salt group）. Stone burden, surgical time, stone free rate, change Of hemoglobin level in peripheral blood and fever were compared with the three groups. Result： The stone volume was10.07 ~ 25.60 cm~ （mean--＋ standard deviation） in oxalate group, 10.91~11.38cm3 in uric acid salt group and 19.19_＋56.16cm3 in phosphate salt group, P^0. 584. The stone free rate was 75.0% in oxalate group, 68.3% in uric acid salt group and 63.3% in phosphate salt group, P：0. 316. The operative time was （76.2±38.9） minutes in oxalate group, （90.4±46.8） minutes in uric acid salt group and （76.6±37.0） minutes in phosphate salt group, P：0. 155. Thirty patients got fever after op- eration in oxalate group, 15 patients in uric acid salt group, 17 patients in phosphate salt group, P=0. 740. The perioperafive hemoglobin level change was （12.6±11.1） g/L in oxalate group, （12.2±11.2） g/L in uric acid salt group, and （10.2±12.1） g/L in phosphate salt group, P〈0. 469. There were 4, 1 and 5 patients received blood transfusion respectively. Conclusion： The efficacy and safety of precutaneous nephrolithotomy for oxalate salt stone, uric acid salt stone and phosphate salt stone were similar.