气压弹道联合钬激光在经皮肾镜碎石中的应用

Percutaneous nephrolithotomy with holmium laser lithotripsy and pneumatic lithotripsy

目的总结经皮肾镜治疗复杂性肾结石中气压弹道碎石和钬激光碎石联合应用的意义。方法回顾性分析122例复杂性肾结石患者的临床资料,其中23例采用气压弹道和钬激光相结合的方法行经皮肾镜碎石,56例单纯采用气压弹道碎石,43例单纯采用钬激光碎石,分析比较其手术时间,出血量,以及结石排净率等指标。结果联合碎石组手术时间(22.6±14.3)min,术中出血(102±46)ml,结石一期排净率82.6%(19/23);气压弹道碎石组手术时间(30.6±19.5)min,术中出血(99±22)ml,结石一期排净率76.8%(43/56);钬激光碎石组手术时间(72.7±34.0)min,术中出血(93±42)ml,结石一期排净率86.0%(37/43)。三组比较,联合碎石组碎石时间最短,有统计学差异(P<0.01)。结论气压弹道碎石和钬激光碎石结合,可以提高碎石效率,缩短手术时间。

Objective To evaluate the therapeutic effect of pneumatic lithotripsy and Holmium laser lithotripsy in percutaneous nephrolithotomy （PCNL） on the treatment of complicated renal calculus. Methods From June 2012 to December 2012, 122 patients with renal calculi were treated with PCNL. 23 patients （group A） were treated with pneumatic lithotripsy combined with Holmium laser lithotripsy to smash and remove the calculi, and only pneumatic lithotripsy was used in group B （56 cases） and Holmium laser lithotripsy was used in group C （43 cases）, respectively. Results Stone-free rate in group A was 82.6% （19/23） in first section, with （22.6±14.3） min operation time and about （102±46） ml blood loss. And the stone-flee rate was 76.8% （43/56） in group B with （30.6±19.5） min operation time and blood loss was about （99±22） mL In group C, stones-free rate was 86.0% （37/43） in first section with （72.7 ±34.0） min operation time and about （93 ±42） ml blood loss. The operation time of PCNL in group A was statistically shorter than those in the other two groups （P 〈0.01）. Conclusion Combination of pneumatic lithotripsy and Holmium laser lithotripsy could improve the efficiency and reduce the operation time of PCNL.