经皮肾穿刺微造瘘取石术治疗复杂性肾结石120例临床观察及体会

Clinical Observation and Experience of 120 Patients with Complex Renal Calculi by Minimally Invasive Percutaneous Nephrolithotomy Lithotripsy Treatment

目的:探讨经皮肾穿刺微造瘘取石术治疗复杂性肾结石的临床疗效与安全性。方法:选择于2009年2月-2011年2月在本院治疗的复杂性肾结石患者120例,随机分为治疗组与对照组,每组60例,治疗组以经皮肾穿刺微造瘘取石术治疗,对照组以常规体外碎石术进行治疗,两组患者术前均给予相应的止痛、解痉、抗炎、补液、中药等对症治疗,对比两组患者的治疗有效率、并发症与不良反应的发生率和住院时间,并于术后1个月进行KUB检查,术后6个月比较两组患者的复发率。结果:治疗结束后,治疗组一次性碎石52例,两次碎石5例,单通道取石55例,多通道取石2例,结石清除率为95%,术中平均出血(145±36)ml,平均手术时间(104±21)min,平均住院时间(6.5±2.3)d,术中无大出血、脏器损伤等并发症,无一例死亡,穿刺成功率为100%,术后大部分患者有轻、中度血尿,3d后自动好转,术后6个月随访有2例复发。对照组一次性碎石21例,两次及以上碎石12例,结石清除率为55%,平均手术时间(96±6)min,平均住院时间(14±2.3)d,无一例死亡,术后大部分患者有轻、中度血尿,3d后好转,患者发热4例、肾绞痛2例、咳血1例,术后6个月随访有9例复发。结论:经皮肾穿刺微造瘘取石术治疗复杂性肾结石具有创伤小、恢复快、并发症少、复发率低的优点,值得临床推广。

Objective：To explore the clinical efficacy and safety of complex renal calculi by minimally invasive percutaneous nephrolithotomy lithotomy treatment.Method：120 patients with complex renal calculi were selected in our hospital from February 2009 to February 2011,all of them were randomly divided into 60 cases of the treatment group and 60 cases of the control group,the treatment group was treated with minimally invasive percutaneous nephrolithotomy lithotomy treatment,the control group was treated with conventional in vitro lithotripsy treatment,the patients of two groups were given preoperative symptomatic treatment analgesic,antispasmodic,anti-inflammatory,rehydration,chinese medicine,compared patients of two groups with treatment efficiency,complications and adversereaction incidence and duration of hospitalization,and after a month KUB check,six months after the recurrence rates of two groups were compared.Result：After the end of treatment,the treatment group,one-time gravel 52 cases,five cases of secondary gravel,single-channel,55 cases of stone,multi-channel,two cases of stone,the stone clearance rate of 95%,the mean blood loss was（145±36）ml,the average operation time was（104±21）min,the average length of stay was（6.5±2.3）d,intraoperative bleeding,organ damage and other complications,with no deaths,puncture success rate of 100%,the majority of patients after surgery with mild to moderate hematuria, 3 d automatically improved 2 cases of patients relapsed after 6 months follow-up,one-time gravel 12 cases. 21 cases of the control group disposable gravel,secondary and higher gravel,stone clearance rate was 55%,the average operation time was（96±6）min,average length of stay（14±2.3）d, with no deaths,after the majority of patients with mild,moderate hematuria,3 d improved after four cases of fever,2 cases of renal colic,one cases of hemoptysis,9 relapsed after 6 months follow-up.Conclusion：Minimally invasive percutaneous nephrolithotomy lithotomy treatment of complex renal calculi with less trauma,quicker recovery,fewer complications,and the advantages of the low recurrence rate,is worthy of promotion.