微创经皮肾镜钬激光碎石取石术与标准通道经皮肾镜钬激光碎石取石术治疗肾结石疗效比较

Comparison between Minimally Invasive Percutaneous Nephrolithotomy Lithotripsy with Holmium Laser and Standard Percutaneous Nephrolithotomy Holmium Laser Lithotripsy in the Treatment of Renal Calculi

目的：评价微创经皮肾镜钬激光碎石取石术治疗肾结石的疗效。方法：选取2010年2月-2012年6月笔者所在医院收治的79例肾结石及肾盂输尿管连接部结石患者，根据手术方法不同，将其分为观察组和对照组，其中观察组41例患者行微创经皮肾镜钬激光碎石取石术治疗，对照组38例患者行标准通道经皮肾镜钬激光碎石取石术治疗，比较两组患者的手术时间、术中失血量、术后住院时间、术后疼痛指数及残石率情况。术后随访时间6~36个月，平均18个月。结果：79例患者均完成手术且恢复良好。对照组手术时间平均（136.0±25.1）min、术中失血量平均（246.0±54.9）ml、术后住院时间平均（9.2±2.5）d、术后疼痛指数（1.7±0.5）、残石7例（18.4%）。观察组手术时间平均（123.0±27.8）min、术中失血量平均（82.0±25.5）ml、术后住院时间平均（7.7±3.2）d、术后疼痛指数（2.1±0.6）、残石6例（14.6%）。两组手术时间、术中失血量、术后住院时间、术后疼痛指数比较，差异有统计学意义（P〈0.05）；而术后残石率两组比较差异无统计学意义（P〉0.05）。13例患者均行彩色多普勒及静脉肾盂造影确认残石，结合体外震波碎石治疗残石。术中术后两组无重大并发症。结论：采用微创经皮肾镜钬激光碎石取石术治疗肾结石是一种有效、安全的微创手术方式，较标准通道经皮肾镜钬激光碎石取石术有较明显优势。

Objective：To assess minimally invasive percutaneous nephrolithotomy with holmium laser lithotripsy of curative effect in the treatment of renal calculi. Method：79 cases of kidney stones and ureteropelvic junctioncalculi patients were treated from February 2010 to June 2012 in author’s hospital, according to the differentoperation method,which was divided into the observation group and the control group,the observation group of 41 patients underwent minimally invasive percutaneous nephrolithotomy with holmium laser lithotripsy treatment,the control group of 38 patients standard tract percutaneous nephrolithotomy holmium laser lithotripsy treatment,compared two groups of patients with operation time,intraoperative bleeding volume,postoperative hospital stay,postoperative pain index and residual stone rate. Postoperative follow-up time was 6-36 months,mean 18 months.Result：All 79 patients completed the operation and good recovery. Control group the average operation time was （136.0±25.1）min,the average intraoperative blood loss （246.0±54.9）ml,postoperative hospitalization time averaged （9.2±2.5）d,postoperative pain index （1.7±0.5）,7 cases had residual stones （18.4%）. Observation group theaverage operation time was （123.0±27.8）min,theaverage amount of bleeding during operation （82.0±25.5）ml,postoperative hospitalization time averaged （7.7±3.2）d,postoperative pain index （2.1±0.6）,6 cases had residual stones（14.6%）. The two groups in operation time,bleeding volume,postoperative hospital stay,postoperative pain index,postoperative residual stone rate comparison,the differences were statistically significant （P〈0.05）. 14 patients underwent color Doppler and intravenous pyelography confirm residual stone,the treatment of residual stones with extracorporeal shock wave lithotripsy. After the two groups no significant complications. Conclusion：Minimally invasive percutaneous nephrolithotomy with holmium laser lithotripsy in the treatmeat renal calculi is a efficient、safe and reliable minimal invasive methods. Minimally invasive percutaneous nephrolithotomy with holmium laser lithotripsy in the treatmeat renal calculi is more advantaged than standard percutaneous nephrolithotomy lithotripsy.