两种通道治疗复杂性上尿路结石的疗效比较

Comparison of efficacy of percutaneous nephrolithotomy by two different channels in treatment of complicated upper urinarytrant calculi

目的比较经皮肾碎石取石术微通道组(percutaneous nephrolithotomy by micro channel,MPCNL)和标准通道组(percutaneous nephrolithotomy by the standard channel,PCNL)治疗复杂性上尿路结石疗效和安全性。方法回顾性分析2005-05至2011-12期间1753例复杂性上尿路结石患者临床资料,其中微通道组1146例和标准通道组607例。对两组患者的手术时间、住院天数、半鹿角和全鹿角型一期结石净石率、手术严重并发症等项指标进行比较。结果两组均成功建立F16和F22经皮肾通道并行碎石取石术。半鹿角和全鹿角形结石患者一期结石净石率微通道组(82.14%)明显低于标准通道组(94.29%),差异有统计学意义。其余部位一期结石净石率无统计学差异。微通道组平均手术时间(72.5±18.5)min明显长于标准通道组(34.1±15.0)min,而平均住院时间前者(9.2±1.9)d少于后者(14.4±3.2)d,前者严重并发症发生率(0.96%)小于后者(2.14%),以上差别均有统计学意义(P<0.05)。结论两种经皮肾通道各有其优点,标准通道碎石效率高,适合一期处理较大的鹿角形结石、肾多发结石、肾感染性结石;微通道适于输尿管上段结石、肾盏单发结石、小于2.5 cm的肾内结石,具有损伤风险低的优势。

Objective To compare the efficacy and safety of percutaneous nephrolithotomy by micro channel （MPCNL） and the standard channel （PCNL） in the treatment of complicated upper tract urinary calculi. Methods 1753 patients with complex upper urinary tract calculi from May 2005 to December 2011 were randomly allocated into MPCNL group （ 1146 cases） and PCNL group （607 cases）, separately. The average operation time and hospital stay, first phase semi -staghorn calculi and full staghom calculi stone clearance rates, serious complications and other indexes were compared. Results In the two groups of 1753 patients, the F16 and F22 channels were successfully established using MPCNL or PCNL. The semi staghorn calculi and full staghorn calculi stone claerance rates in MPCNL group were significantly lower than those in PCNL group （82.14%） vs （94.29%） （P 〈0.05）. The stone clearance rate of the remaining parts showed no differences. MPCNL was associated with longer operation time （72.5 ± 18.5） mins vs （34.1 ±15.0 ） mins （ P 〈 0.05 ）, shorter average hospital stay （ 9.2± 1.9 ） days vs （ 14.4± 3.2 ） days （ P 〈 0.05 ）, and lower rate of severe complications（0.96% ） vs （2.14%） （P 〈 0.05）. Conclusions Both MPCNL and PCNL have their own advantages. The standard channel PCNL combined with EMS stone clearance system is highly efficient, suitable for larger pelvic stones, multiple kidney stones, and infective kidney stones. The MPCNL is suitable for upper ureteral calculi, calyceal single stones, less than 2.5 cm renal stones. The MPCNL has lower risk of damage.