微创经皮肾镜取石术治疗肾结石的临床研究

Clinical studies of minimally invasive percutaneous nephrolithotomy in treatment of kidney stones

目的：旨在对比分析微创经皮肾镜取石术治疗肾结石与传统开放性手术治疗肾结石的手术效果。方法收集2009年1月-2014年1月来我院进行治疗的肾结石患者120例，所有患者均有完整的临床资料，其中60例为行传统肾窦内肾盂切开取石术，设立为对照组，其余60例行微创经皮肾镜取石术，设立为微创组，比较两组的手术时间、术中出血量、术后造瘘时间及住院时间及并发症。结果微创组60例患者均一期穿刺成功并顺利碎石，取石成功58例，成功率96.7%（58/60）。术中未出现气胸、结肠损伤等并发症，一次清石率为80.0%（48/60）。术后生命体征平稳，无肾切除、伤口尿瘘、液气胸等严重并发症发生。4例泌尿系感染者术后出现持续高热，经抗感染治愈。对照组术中出现十二指肠损伤1例、腹膜损伤2例、术后出现高热2例、肠瘘1例，泌尿系感染8例。观察组与对照组的手术时间、术中出血量、术后造瘘时间及住院时间比较，差异有统计学意义（P〈0.05或 P〈0.01）。结论微创经皮肾镜取石术治疗肾结石具有创伤小、出血少、并发症少等优点，且可缩短住院时间，值得推广和应用。

Objective To compare and analyze the effect of minimally invasive percutaneous nephrolithotomy compare with traditional open surgical in treatment of kidney stones outcome. Methods Selected 120 patients with kidney stones from January 2009 to January 2014 in our hospital, all patients had complete clinical data, included 60 cases of renal sinus traditional lines pelvis lithotomy, established as the control group, and the remaining 60 routine minimally inva-sive percutaneous nephrolithotomy surgery, set up minimally invasive group, the operative time, blood loss, postoperative fistula time and hospital stay and complications were compared between two groups. Results 60 patients with invasive group homogeneity of puncture success and smooth gravel, stone successful in 58 cases, the success rate was 96.7%（58/60）. Intraoperative complications pneumothorax, colon injury does not appear, one-time stone clearance rate was 80.0%（48/60）. Stable vital signs after surgery, no nephrectomy, severe complications wound fistula, pneumothorax oc-curred. 4 cases of postoperative urinary tract infection sustained high fever, anti-infection cure. 1 case duodenal injury control group intraoperative peritoneal injury in 2 cases, 2 cases of postoperative fever, intestinal fistula, urinary tract infection in 8 cases. Operative time, blood loss, postoperative fistula compare the time and duration of hospitalization, of observation group improved significant than the control group, the difference was statistically significant （P〈0.05 or P〈0.01）. Conclusion Minimally invasive percutaneous nephrolithotomy in the treatment of kidney stones with less trau-ma, less bleeding, fewer complications, shorter hospital stays and can be worthy of promotion and application.