经皮肾镜辅助小切口取石术在高危结石患者中的临床应用价值分析

The clinical application value of small-incision assisted percutaneous nephrostolithotomy among high risk patients

目的：探讨经皮肾镜辅助小切口取石术在合并糖尿病、高血压病及再次手术结石患者中的临床应用价值。方法：观察组20例采用经皮肾镜辅助小切口取石术式，手术切口长5～7cm，肾脏穿刺通道用2—0可吸收缝合线全层缝合，不留置肾造瘘管，肾周不留置血浆引流管。对照组21例采用经皮肾镜取石术式，留置F18～50肾造瘘管。两组患者均使用瑞士EMS-Vario混合动力碎石清石系统进行手术。结果：两组中合并糖尿病、高血压病及再次手术患者人数比较，差异无统计学意义。观察组患者无大出血、气胸、邻近脏器损伤等严重并发症，伤口均甲、乙级愈合，随访3个月无继发性肾出血。对照组继发性肾出血4例，发生率19．05％，经超选择性肾动脉介入栓塞治疗后痊愈出院。结论：经皮肾镜辅助小切口取石术能有效降低合并糖尿病、高血压病及再次手术患者继发性肾出血的发生率，有实际临床应用价值。

Objective：To explore the clinical application value of small-incision assisted percutaneous nephros- tolithotomy（PCNL） among patients who suffer from diabetes mellitus, hypertension and re-operation. Methods： The small-incision assisted PCNL was used in experimental group （20 cases）, which the operative incision was 5- 7 cm long, sewed up by 2-0 absorbable suture. Nephrostomy tube and blood plasma tube were not reserved. Meanwhile the PCNI. was used in control group （21 cases）, which the NO. F18-20 nephrostomy tube was reserved. However the Swiss Litho Clast Msater VARIO was used in two groups. Results：The difference of the cases of the patients who suffered from diabetes mellitus, hypertension and re-operation between two groups was not statisti- cally significant （P〈0.05）. No hemorrhea, pneumothorax, injury of peripheral organs and other serious compli- cation occurred in experimental group. The incision healed on the first or second level, and the related nephrorrha- gia did not occur after 3 months. However, there were 4 cases occurring related nephrorrhagia in control group （incidence rate was 19.05 %） who were healed by super selective renal artery embolization. The difference of the related nephrorrhagia between the two groups was statistically significant （P〈0. 05）. Conclusions：The small-inci- sion assisted PCNL can effectually reduce the incidence rate of the related nephrorrhagia among the patients who suffered from diabetes mellitus, hypertension and re-operation. The value of clinical application is obvious.