经皮肾镜气压弹道联合超声碎石术治疗肾结石的疗效研究

Clinical analysis of treatment to patients with kidney stones by using percutaneous nephrolithotomy(PCNL)combined with ultrasonic lithotripsy(USL)

目的探讨经皮肾镜气压弹道超声碎石术联合超声碎石术治疗肾结石的临床疗效及安全性。方法2011年5月至2013年10月该院治疗的196例肾结石患者,分为观察组和对照组,各98例。对照组患者采用经皮肾镜气压弹道碎石术,观察组患者使用经皮肾镜气压弹道联合超声碎石术。比较2组患者的手术情况,Ⅰ、Ⅱ期结石清除率及术后并发症发生情况,并通过SF-36量表对2组患者手术安全性进行评价。结果 2组患者在手术时无严重并发症发生,观察组患者的手术时间、术中出血量及术后住院时间均少于对照组,差异有统计学意义(P<0.05)。观察组患者的Ⅰ期结石清除率(79.6%)明显优于对照组(54.1%),差异有统计学意义(χ2=14.386,P<0.05),且Ⅱ期结石清除率(95.0%)也明显高于对照组,差异有统计学意义(66.7%)(χ2=5.990,P<0.05);观察组患者术后出现1例并发症(1.0%),明显少于对照组的7例(7.1%),差异有统计学意义(χ2=4.671,P<0.05)。术前2组患者的SF-36量表评分差异无统计学意义(P>0.05);术后对照组患者SF-36各项评分均低于观察组,差异有统计学意义(P<0.05)。结论采用经皮肾镜气压弹道超声碎石术治疗肾结石疗效更好,操作简便安全,并发症较少,具有临床价值。

Objective To explore the clinical curative effects and safety of treatment for the patients with kidney stones by using ultrasonic lithotripsy（USL）combined with percutaneous nephrolithotomy（PCNL）.MethodsThe clinical data of 196 cases patients with kidney in our hospital from May 2011 to October 2011 stones were retrospectively analyzed.The 196 patients were divided into two groups（98cases in each group）according to the treatment methods：the observation group having percutaneous nephrolithotomy（PCNL）treatment and the control group given ultrasonic lithotripsy（USL）treatment;Operation situation,the phase I and phaseⅡ stone clearance rates and postoperative complications of the two groups were recorded and compared;Also the SF-36 scale comparative evaluation were used to study the safety of two groups′surgery.Results Two groups of patients all had successfully completed surgery,and no serious complications happened during surgery;The operation time,intraoperative blood loss and postoperative hospital stay of the observation group,were all less than those of the control group（P〈0.05）;After treatment,the observation group′s phaseⅠ stone clearance rate was 79.6% which was obviously better than the control group′s 54.1%（χ2=14.386,P〈0.05）,also the observation group′s phaseⅡ stone clearance rate of 95.0%was significantly higher than the control group′s 66.7%（χ2=5.990,P〈0.05）;There was only one case（1.0%）of postoperative complications happened in the observation group while the control group had 7cases（7.1%）postoperative complications（χ2=4.671,P〈0.05）;Preoperative SF-36 scale scores of the two groups patients had no difference（P〉0.05）while the control group′s postoperative SF-36 scores were all lower than those of the observation group,which had significant differences（P values all 0.05）.Conclusion Using PCNL combined with USL to treat kidney stones has more definite curative effects and safety,less complications,which is also more convenient for operation and worthy of clinical promotion.