标准通道、微通道经皮肾镜取石术治疗巨大肾结石的对比研究

Comparative study of standard percutaneous nephrolithotomy and mini-percutaneous nephrolithotomy in the treatment of huge renal calculi

目的：总结标准通道、微通道经皮肾镜取石术（mini—percutaneousnephrolithotomy，MPCNL）治疗巨大结石（结石负荷〉6cm）的临床效果及操作体会。方法：2001—2013年采用标准通道经皮肾镜取石术（percutaneousnephrolithotomy，PCNL）治疗巨大肾结石患者210例，以MPCNL治疗巨大肾结石患者83例。回顾分析两组患者的临床资料。对比两组术后结石清除率、术后发热、大出血、败血症、集合系统损伤、肾周感染、肾盂输尿管连接部狭窄等情况。结果：PCNL组手术时间平均（85±30．2）min，术后发热（体温〉38．5℃）49例（23．3％），术中输血27例（12．9％），败血症5例（2．4％），尿外渗11例（5．2％），清石率为96．7％。MPCNL组手术时间平均（108±33）rain，术后发热20例（24．1％），输血12例（14．5％），败血症3例（3．6％），尿外渗4例（4．8％），清石率86．7％。PCNL组清石率较高（P〈0．05），两组并发症发生率差异无统计学意义（P〉0．05）。结论：手术操作的关键在于术中建立妥善的皮肾通道、术后预防并发症的发生。标准通道PCNL治疗巨大肾结石效果肯定。

Objective： To summarize the treatment effect and experience of standard percutaneous nephrolithotomy （PCNL） and mini-percutaneous nephrolithotomy （MPCNL） in the treatment of huge calculi （ 〉 6 cm）. Methods：A total of 210 patients who suffered from huge renal calculi were treated with PCNL in Yijishan Hospital during 2001 and 2013 ,while 83 patients were treated with MPCNL. The clinical data of the 2 groups were retrospectively analyzed. The postoperative stone clearance rate, fever, hemorrhage, sep- sis,collecting system injury, perirenal infection and ureteropelvic junction stenosis of the 2 groups were compared. Results：In PCNL group,postoperative fever （ 〉 38.5~C ） rate was 23.3% （n = 49） ,27 cases （ 12.9% ） needed blood transfusion,5 cases （2.4%） in- fected septicemia, 11 cases （5.2%） had urecchysis. The stone clearance rate was 96.7%, time of operation was （85 ~ 30.2） rain. In MPCNL group,fever rate was 24.1% （20 cases） ,12 cases （ 14.5% ） needed blood transfusion,the rate of septicemia was 3.6% （3 cases）, extravasation urine rate was 4.8% （4 cases）. The stone clearance rat was 86.7%, which was lower than that of PCNL group （ P 〈 O. 05）. The operation time was （ 108 ~ 33） min. There was no difference in complications between the 2 groups （ P 〉 O. 05）. Con- clusions ： Standard PCNL has affirmative effects, and is better in curative effect compared with MPCNL for huge kidney stone. The key of operation includes intraoperative appropriate creation of percutaneous renal access and postoperative prevention of complications.