微创经皮肾镜联合膀胱软镜治疗复杂性肾结石的疗效观察

Effect of minimally invasive percutaneous nephrolithotomy combined with flexible cystoscope for complex renal calculi

目的探讨微创经皮肾镜联合膀胱软镜治疗复杂}生肾结石的临床应用效果。方法选取石河子大学医学院第一附属医院2011年10月至2013年6月间复杂性肾结石患者23例，均行单通道微创经皮肾镜气压弹道碎石联合膀胱软镜钬激光碎石治疗。同期对照组22例，单行微创经皮肾镜气压弹道碎石治疗。术后均保留。肾造瘘管3～5d，尿管2～3d，双J管4～8周。比较两组的手术时间、术中出血量、一期清石率、术后住院时间和并发症发生情况。结果联合手术组患者手术时间（90±36）min，出血量（57±17）ml，术后住院时间（7±2）d，均无严重并发症发生。与对照组比较，联合手术一期清石率95．65％，对照组为68．18％，清石率踢显提高（P〈0．05），术中出血量较少，术后并发症明显改善（P〈0．05）。联合组一期手术时间较对照组略长，术后恢复时间无显著性差异（P〉0．05）。结论微创经皮肾镜联合膀胱软镜治疗复杂性肾结石是一种安全有效的方法。

ObjectiveTo evaluate the clinical effect of minimally invasive percutaneous nephrolithotomy combined with flexible cystoscope for complex renal calculi. Methods Data of 45 cases of complex renal calculi treated during Oct 2011 to Jun 2013 were retrospectively analyzed. The 45 cases were randomly divided into two groups. 22 patients in the control group were treated with minimally invasive percutaneous nephrolithotomy. 23 patients in the experimental group were treated with minimally invasive percutaneous nephrolithotomy combined with flexible cystoscope. After operation renal fistula was maintained for 3-5 d, urethral catheter for 2-3 d, and double-J stent for 4-8 weeks in all cases. The operation time, volume of blood loss, one- stage stone- free rates, postoperative hospital stay and related complications were compared between two groups. Results In the experimental group, mean operation time was （90±36） min, mean volume of blood loss was （57＋17） ml, mean postoperative hospital stay was （7±2） d. No obvious complications were observed. Compared with the control group,there was no significant difference in the mean operation time and postoperative hospital stay （P〉0.05）. The one-stage stone-free rates for the experimental and control groups were 95.65% and 68.18% （P〈0.05）. And there was statistical difference in the volume of blood loss and serious complications between the two groups （P〈0.05）. Minimally invasive percutaneous nephrolithotomy combined with flexible cystoscope is a effective and safe way for complex renal calculi.