钬激光和EMS在经皮肾镜治疗鹿角型肾结石中的临床疗效比较

Clinical Effect Comparison Between Holmium Laser and EMS When Used in Combination with Percutaneous Nephrolithotomy(PCNL) to Treat Staghorn Calculi

目的比较经皮肾镜采用钬激光和第四代EMS(Electro Medical Systems,EMS)碎石清石系统治疗复杂性肾结石的临床疗效及安全性。方法回顾性分析经皮肾镜联合钬激光或第四代EMS碎石清石系统治疗鹿角型肾结石患者832例的临床资料,观察平均碎石清石时间、平均出血量、近期和远期结石清除率及手术严重并发症等指标,比较两种碎石方法的疗效及安全性。结果 832例患者均一期成功建立经皮肾镜通道,所有病例均单通道碎石。钬激光组术后5 d结石清除率为76.0%,平均碎石时间(51±6.3)min,平均碎石清石时间(97±5.6)min,平均出血量(75.3±7.6)ml。EMS组术后5 d结石清除率为83.5%,,平均碎石清石时间为(78±5.0)min,平均出血量(65±7.0)ml。术后1个月时钬激光组和EMS组结石排除率分别为87.0%和91.8%。两组相比,EMS组的平均碎石清石时间、术中出血量、近期及远期结石清除率均优于钬激光组(P<0.05)。所有病例均未出现顽固性高热、严重血尿、肾周血肿、气胸、穿孔、肾功能损伤等严重并发症。结论经皮肾镜联合EMS碎石清石系统治疗鹿角型肾结石与钬激光相比,具有更加安全、高效的优势。但对于质地较硬的结石两者联合可取得更好的效果。

Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy （PCNL） combined with Holmium laser or EMS in the treatment of staghom calculi. Methods Eight hundred and thirty two patients with staghom renal calculi were given PCNL and Holmium laser or EMS. The average gravel time, lithotripsy time and bleeding amount and stone clearance rate 5 days and a month after the operation were Observed and the clinical efficacy and safety analyzed respectively. Results All patients were stabbed successfully on the in-st try, and the stones were removed via a single channel As to the HoLmium laser group, the stone clearance rate 5 days after the operation was 76. 0%, the average gravel .time （ 51±6. 3 ） rain,the average litho- tripsy time （97± 5.6） min, and the average bleeding amount （75.3± 7.6 ） nd. On the other hand, in the EMS group, the stone clearance rate 5 days after the operation was 83.5%, the average lithotripsy time （ 78 ± 5.0） min, and the average bleeding amount （ 65 ± 7.0） nd. The stone clearance rates of these two groups one month after the operation were 87.0% and 91.8%. The EMS group performed better than the HoLmium laser group in average gravel time, average lithotripsy time, average bleeding amount as well as stone clearance rate. No serious complication, such as intractable high fever, severe hematuresis, perirenal hematoma, pneumothorax, perforation, kidney damage and other serious complications, was observed. Conclusions EMS is more safe and efficient than Holmium laser when used jointly with PCNL tO treat staghom renal calculi. Howev- er, the combination of EMS and Holmium laser may have morv desirable effect on hard texture stones.