微创经皮肾穿刺碎石术(MPCNL)治疗上尿路结石的临床分析

Clinical Analysis of Minimally Invasive Percutaneous Nephrolithotomy for Treatment of Upper Urinary Calculi

目的:探讨微创经皮肾穿刺碎石术(MPCNL)用于治疗尿路结石的临床效果。方法:选取120例单侧上尿路结石病患者,随机分为两组,每组60人。一组应用微创经皮肾穿刺碎石术(MPCNL)进行一期单通道上尿路取石,另一组采用开放手术治疗。比较并分析两组患者的临床疗效。结果:应用MPCNL治疗的60名患者中,结石清除的有55名,清除率为91.17%,手术时间平均为77分钟,住院时间平均为5.3天。术中平均出血100 mL,术后发生大出血者一例,经输血后好转,术后发热者38例,发热比例为63.3%,尿液转清时间平均为2.5天。应用开放式手术的60名患者中,结石清除的有39例,清除率为65.0%,平均手术之间为112分钟,住院时间平均为18.1天,术中平均出血380 mL,术后发生大出血者9例,经输血后好转,术后发热者43例,发热比例为71.2%,尿液转清时间平均为8.6天。结论:MPCNL方法治疗上尿路结石的效果明显比开放式手术好,具有清除率高、手术时间短、术后并发症少、术后感染少以及患者恢复快的优点。

Objective： To discuss the clinical efficacy of minimally invasive percutaneous renal biopsy lithotripsy （MPCNL） on the treatment of urinary stones. Methods： 120 cases with unilateral urinary stones who were treated in our hospital were selected and randomly divided into two groups with 60 patients in each group. 60 cases were treated with the minimally invasive percutaneous renal puncture lithotripsy （MPCNL） for a period of single channel urinary lithotomy, while another 60 patients were treated by open surgery. Then the clinical efficacy of patients in the two groups were compared and analyzed. Results： Among the 60 patients who were treated by MPCNL, 55 of them were removed and the clearance rate was 91.17%, the average time of surgery was 77 min, and the hospitalization was 5.3 days on average, the mean volume of bleeding was 100 mL during operation, one case was complicated with severe bleeding after proce- dure and with blood transfusion and changed into open surgery. 38 cases showed fever after operation and the rate was 63.3%. The aver- age time of blood urine was 2.5 days. In the 60 patients who has treated by opened operation, the stone clearance rate was 65.0%, the mean operative duration was 112minutes, the average hospital stay was 18.1 days, the average volume of bleeding was 380 mL during operation, 9 cases were complicated with severe bleeding after operation and with blood transfusion, 43 cases were fever after operation and the rate was 71.2%, the average time of blood urine was 8.6 days. Conclusion： High clearance rate, short operation time, less post- operative complications, patients with less postoperative infection and recovery fast are the merits of MPCNL whose effect is obviously better than open surgery.