微小针道辅助单通道MPCNL治疗肾结石的临床应用研究

Mini needles assisted single-channel minimally percutaneous nephrolithotomy for renal calculi

目的：探讨微小针道在辅助单通道微创经皮肾镜取石术（minimally invasive percutaneousnephrolithotomy，MPCNI。）中处理复杂性肾结石的临床价值。方法：我院2013年3月～2014年3月行多通道MPCNI。手术79例（A组），2014年3月--2015年3月行微小针道辅助单通道MPCNL手术57例（B组）。回顾性分析两组的手术时间、标准通道建立时间、术中出血量、一期结石清除率以及术后肾造瘘管出血时间、并发症发生率、术后血红蛋白下降值、术后输血例数和术后住院时间，比较两组不同术式治疗肾结石患者的疗效和安全性。结果：两组136例手术均获得成功。其中A、B两组一期结石清除率分别为95％和96％；与A组相比，B组建立通道和总手术时间更短（P〈0．001），术中出血量较小（P=0．038），并发症发生率较低（7．0％vs15．2％），血红蛋白值下降更少（P=0．024），术后住院时间明显缩短（P=0．003）。结论：微小针道辅助单通道MPCNL在治疗和处理肾结石方面弥补了单一通道经皮肾穿刺取石的不足，避免了多通道的刨伤，安全高效。

Objective：To investigate the clinical value of mini needles assisted single-channel minimally percuta- neous nephrolithotomy （MPCNL） in the treatment of complicated kidney stones. Method： There were 79 cases who underwent multiple-channel MPCNL from Mar. 2013 to Mar. 2014 in group A. There were 57 cases who un- derwent mini needles assisted single-channel MPCNL from Mar. 2014 to Mar. 2015 in group B. Clinical data including operation time, standard channel establishing time, intraoperative blood loss, one-stage stone free rate, renal fistula bleeding time, incidence of complications, hemoglobin decline, blood transfusion cases and postopera- tive hospital stay were retrospectively analyzed and compared between group A and group B. Result： All 136 pa- tients succeeded in Operation, The stone free rate was 950/oo in group A and 96O//oo in group B, respectively. Com- pared with group A, group B spent less time in operation and establishing standard channel （P〈0. 001）, experienced less blood loss during operation （P=0. 038）, lower incidence of complications （7% vs 15.2%）, less hemoglobin decline （P=0. 024 ）, and shorter hospital Stay （P=0. 003）. Conclusion： Mini,needles assisted single-channel MPCNL for renal calculi is effective and safe for it can avoid the deficiency of single-channel MPCNL and reduce the trauma from multiple-channel procedure.