开放手术联合术中肾镜超声或气压弹道治疗复杂性巨大肾结石

目的探讨复杂性巨大肾结石的治疗方法及开放手术在巨大肾结石治疗中的价值。方法复杂性巨大肾结石患者128例，按照手术方式不同分为两组，其中经皮肾镜取石术（PCNL）（A组）70例；开放手术联合术中肾镜超声碎石或气压弹道碎石组（B组）58例；比较两种手术方式的疗效。结果两组间年龄、性别、结石大小、结石位置差异无明显统计学意义（P〉0．05）；B组在平均手术时间、术中出血量、结石清除率及术后并发症的发生率明显优于A组，差异有统计学意义（P〈0．05）。结论对于复杂性巨大肾结石尤其是铸型肾结石，经皮肾镜治疗相对困难，应用开放手术联合肾镜超声碎石或气压弹道碎石治疗，手术时间短、结石清除率高、并发症少。

Objective To explore the methods of treatment for complicated renal calculi and the value of Pelvilithotomy in the treatment of complicated renal calculi. Methods A retrospective analysis of 128 complicated renal calculi cases from 2011 January to 2014 August, which was divided into two groups by the different methods of operation, PCNL （ A ） group and Pelvilithotomy combined with Nephroscopic Pneumatic or Ultrasound Lithotripsy （ B ） group. All of the operations were performed by the same surgeon. The clinical datas including operation time, blood loss, Stone clearance, postoperative hospital stays and the incidence of complications were statistically analyzed to evaluate the effect of two groups of operation method. Results Two groups of patients in age, gender, stone diameter, stone location had no statistically significance （ P〉0.05 ） . Operations were performed successfully in all patients, postoperative hospital stay of the A group and B group was （ 11.1 ± 1.6 ） days and （ 11.1 ± 1.9 ） days, and had no significant difference in two groups （P〉0.05） . The operation time of the A group and B group was （ 128.5 ＋ 16.2 ） min and （ 102.3 ± 13.4 ） min respectively, and had significant difference in two groups （ P〈0.01 ） . The blood loss during the operation of the A group and B group was （ 473.6 ± 61.7 ） ml and （ 351.8 ±80.9 ） ml, and had significant difference in two groups （ P〈0.01 ） . The stone-free rate of the A group and B group was 68.6% （ 48/70 ） and 84.5% （ 49/58 ） respectively, and had significant difference in two groups （ P〈0.05 ） . The the incidence of complications of the A group and B group was 35.7% （ 25/70 ） and 17.2% （ 10/58 ） respectively, and had significant difference in two groups （ P〈0.05 ） . Conclusions For complicated renal calculi especially kidney staghorn calculi, PCNL is a relatively difficult treatment, but with the method of pelvilithotomy combined with nephroscopic Pneumatic or Ultrasound Lithotripsy, we can obtain a curative effect of Shorter operation time, a higher stone-free rate and less complication. In addition, Pelvilithotomy combined with Nephroscopic Pneumatic or Ultrasound Lithotripsy is also a relatively safer therapy for renal infectious stones.