经皮肾镜Cyberwand双导管超声联合输尿管镜碎石清石术治疗肾铸型结石疗效分析

ANALYSIS OF THE EFFECT OF PERCUTANEOUS ULTRASONIC NEPHROLITHOTOMY WITH CYBERWAND DUAL PROBE AND URETEROSCOPY LITHOTRIPSY IN TREATING RENAL STAGHORN CALCULI

目的探讨C臂X线引导下经皮肾镜Cyberwand双导管超声联合输尿管镜碎石凊石术治疗肾铸型结石的临床效果。方法回顾性分析2011年1月～2012年12月150例肾铸型结石患者的临床资料,随机分成对照组(n=75)和治疗组(n=75),分别采用经皮肾镜Cyberwand双导管超声碎石清石术和经皮肾镜Cyberwand双导管超声联合输尿管镜碎石清石术治疗,统计并比较两组的住院时间、手术时间、术中出血量、结石清除率及并发症发生情况。结果 150例均成功建立20F皮肾通道,治疗组Ⅰ期完成手术53例,二期完成手术22例。手术时间36～150 min,平均(62.8±11.3)min。术中出血量10～400 ml,平均(50.7±12.6)ml。一次完全取净结石56例,清石率为74.7%;残留结石19例,其中残余小结石5例,泥沙样结石3例,行体外冲击波碎石治疗后结石排净,11例因术中出血视野模糊导致残余结石较大(直径>2 cm),行二次手术结石取净。住院时间7～10 d,平均(8.2±1.5)d。随访1～9个月,均无迟发性出血、严重感染等并发症。对照组Ⅰ期完成手术45例,二期完成手术30例。手术时间30～240 min,平均(121.5±16.8)min。术中出血量10～800 ml,平均(112.5±10.3)ml。一次完全取净结石43例,清石率为57.3%;残留结石32例,其中残余小结石6例,泥沙样结石4例,行体外冲击波碎石治疗后结石排净,13例因术中出血视野模糊导致残余结石较大(直径>2 cm),行二次手术结石取净,9例因残留结石较大行三次手术取尽。住院时间7～20 d,平均(12±2.6)d。随访1～9个月,均无迟发性出血、严重感染等并发症。治疗组手术时间、术中出血量、住院时间均显著低于对照组,组间比较差异有统计学意义(p<0.05);治疗组术后结石清除率显著高于对照组,组间比较差异有统计学意义(p<0.05);两组并发症发生率比较差异无统计学意义(p>0.05)。结论经皮肾镜Cyberwand双导管超声联合输尿管镜碎石清石术治疗肾铸型结石可以提高手术清石率,缩短手术时间、住院时间,减少手术次数,不增加副作用,具有良好的临床应用价值。

Objective To explore treatment and clinical effectiveness of C -arm X -ray machine -guided percutaneous nephrolithotomy with dual probe ultrasonic and Ureteroscopy lithotripsy in the treatment of renal staghorn calculi. Methods Clinical data of 150 cases with renal staghorn calculi from January 2011 to December 2012 were analyzed retrospectively. They were randomly divided into control group （72 cases） and treatment group（78 cases）, treated respectively by C -arm X -ray machine -guided pereutaneous nephrolithotomy with dual probe ultrasonic （control group） and with the same method combined Ureteroscopy lithotripsy（ treatment group）, then the hospital stay, operative time, blood loss, complications and stone clearance rate of two groups were compared. Results The percutaneous renal accesses were successfully established under C - ann X - ray machine - guidance. The treatment group and control group perform phase one operation in 53/45 patients, phase two operation 22/30 cases. The operative duration was 36 ± 150/30 ± 240minutes, averaged （ 62. 8 ± 11.3/121.5 ± 16. 8 ） minutes. The intraoperative blood loss wasl0 ±400/10 ± 800 ml, averaged （50. 7 ± 12. 6/112.5 ± 10. 3） ml. 56/43cases were discharged completely in first phase operation and the stone clearance rate was74.7%/57.3%. 8/10cases were treated by ESWL due to residual stones and the residual stones were discharged completely. 11/13 cases with big residual stones due to intraoperative bleeding induced view fuzzy was performed second operation, and 9 control group cases was performed third operation. The length of hospitalization was7 ± 10/7 ±20 days, averaged （8.2 ± 1.5/12 ±2. 6） days. No severe complications such as delayed hemorrhage and severe infection were found during 1 to 9 months follow up. The operative duration, the intraoperative blood loss and the length of hospitalization of treatment group were significantly lower than control group （p 〈 0. 05 ）;the stone clearance rates were significantly higher, the differences between groups were statistically significant （p 〈 0. 05 ）, the incidence of complications between groups had no statistically difference （p 〉 0, 05 ）. Conclusion Percutaneous nephrolithotomy with dual probe ultrasonic and ureteroscopy lithotripsy in the treatment of renal staghorn calculi can effectively improve the stone clearance rates, shorten the operation time and the length of hospitalization, reduce the number of operation, does not increase the operation complications, so it has good clinical application value.