经皮肾镜钬激光碎石术与双导管超声碎石术治疗鹿角型肾结石的比较

The comparision of dual-probe ultrasonic lithotripsy and Holmium laser lithotripsy in percutaneous nephrolithotomy

目的比较钬激光碎石与双导管超声碎石在经皮肾镜手术中的临床疗效和安全性。方法回顾性分析我院2010年1月至2012年6月131例鹿角型肾结石患者的临床资料,其中双导管超声碎石组51例,钬激光碎石组80例,比较两种碎石方法在手术时间、术中估计出血量、结石清除率、术后并发症发生率及术后住院时间等方面的差异。结果两组患者在性别、年龄、身体质量指数(BMI)、结石大小及位置上无差别(P>0.05)。双导管超声碎石组术中手术时间及平均估计出血量显著低于钬激光组(52.1±25.1 min vs.78.4±33.9 min,P<0.001;101.7±25.8 ml vs.124.2±18.4 ml,P<0.001)。双导管超声碎石组平均术后住院日为7.1 d,钬激光碎石组为6.4 d,组间差异无统计学意义。双导管超声碎石组结石清除率为90.2%,钬激光碎石组结石清除率为81.3%,二者差异无统计学意义(P>0.05)。两组患者总的并发症发生率相当(13.7%vs.26.3%,P=0.09),但双导管碎石组感染性并发症发生率显著低于钬激光碎石组(7.8%vs.21.3%,P=0.04)。结论与钬激光碎石术相比,双导管超声碎石术具有手术时间短、出血少、术后感染性并发症少等优点,值得临床推广应用。

Objective To compare the safety and clinical efficacy of dual-probe ultrasonic lithotripsy （DUL） and holmium laser lithotripsy （HLL） in percutaneous nephrolithotomy. Methods Patients with staghore stone were treated by pereutanous nephrolithotomy with dual-probe ultrasonic lithotripsy （n=51） or holmium laser lithotripsy （n=80）. Demographic and clinical data, including preoperative indexes, intraoperative indexes and complications, were retrospectively compared to determine the efficacy and safety of the two procedures. Results The DUL and HLL groups were statistically similar in age, sex, BMI, stone load and stone location. DUL group was associated with a significantly shorter operative time and less intraoperative estimated blood loss （52.1±25.1 min vs. 78.4±33.9 min, P〈0.001, 101.7±25.8 ml vs. 124.2±18.4 ml, P〈0.001, respectively）. The duration of postoperative hospital stay required for both groups were statistically similar （P〉0.05）. The stone clearance rate of DUL was slightly higher than that of HLL, but the differences weren＇t statistically significant （90.2% vs. 81.3%, P〉0.05）. However, the infectious complication rate in the HLL group was 21.3%, and it was 7.8% in the DUL group, of which differences were statistically significant （P=0.04）. Conclusions Compared with HLL, the DUL procedure requires a shorter operative time, less intraoperative estimated blood loss and lower infectious complications rate. Thus, DUL is recommended as the preferred strategy.