不同径路经皮肾镜取石术治疗肾结石及输尿管上段结石的疗效比较

The efficacy comparison of percutaneous nephrolithotomy in the treatment of kidney calculi and upper ureteral calculi in different pole access

目的探讨不同径路经皮肾镜取石术(PCNL)在治疗肾结石及输尿管上段结石的疗效差异。方法对392例肾结石以及输尿管上段结石患者行PCNL术,分成肾上盏结石或肾盂结石组、肾下盏结石组、鹿角形结石组和输尿管上段结石(合并或不合并肾结石)组,并从一期结石完全清除率、手术时间、穿刺成功率三方面评估不同径路的疗效差异。结果肾上盏结石或肾盂结石组:一期结石完全清除率分别为89.4%和95.1%(P=0.226),手术时间分别为(77.76±5.04)和(81.09±4.14)min(P=0.263),肾下盏结石组:一期结石完全清除率分别为90.9%和80%(P=0.646),手术时间分别为(75.32±9.23)和(84.5±15.27)min(P=0.204),鹿角形结石组:一期结石完全清除率分别为88.2%和72.3%(P=0.012),手术时间分别为(118.69±3.28)和(141.08±4.78)min(P<0.001),输尿管上段结石组:一期结石完全清除率分别为89.7%和64%(P=0.021),手术时间分别为(98.98±6.12)和(115.56±6.98)min(P<0.001)。穿刺成功率为100%。结论对于鹿角形结石和输尿管上段结石,经上盏径路的手术结石清除率更高,手术时间更短。

【Objective】To compare the difference of percutaneous nephrolithotomy in the treatment of kidney calculi and upper ureteral calculi in different pole access. 【Methods】The percutaneous nephrolithotomy was performed in 392 cases, 128 cases of renal upper calyx calculi or pelvic stones, 32 cases of lower calyx calculi, 158 cases of antler shape stone, 74 cases of upper ureter calculi combined with kidney stones or not,and evaluated the differences in the first period calculus completely clearance rate, operation time and puncture success rate in different access. 【Results】For renal upper calyx calculi or pelvic stones, the first period calculus completely clearance rate was respectively 89.4% and 95.1%（P〈 0.05）, operation time was respectively（77.76±5.04） and（81.09±4.14） min（P〈 0.05）. To lower calyx calculi the first period calculus completely clearance rate was 90.9% and 80%, respectively（P〈 0.05）, operation time was（75.32±9.23） and（84.5±15.27） min（P〈 0.05）, respectively. For antler shape stone the first period calculus completely clearance rate was 88.2% and 72.3%（P〈 0.05）, respectively, operation time was（118.69±3.28） and（141.08±4.78） min（P〈 0.05）, respectively. For upper ureter calculi combined with Kidney stones or not the first period calculus completely clearance rate was 89.7% and 64%（P〈 0.05）, respectively, operation time was（98.98±6.12） and（115.56±6.98） min（P〈 0.05）, respectively. The puncture success rate was 100% to all the cases.【Conclusion】For antler shape stone and upper ureter calculi through upper pole access, the first period calculus completely clearance rate is higher and operation time is shorter.