后腹腔镜肾切开取石与经皮肾镜取石术治疗复杂性肾结石的临床疗效比较

Efficacy of retroperitoneal laparoscopic nephrolithotomy vs. percutaneous nephrolithotomy in patients with complex renal calculi

目的比较后腹腔镜肾切开取石与经皮肾镜取石术（PNL）治疗复杂性肾结石的临床疗效。方法选取本院2010年1月至2014年12月收治的126例复杂性肾结石，其中行后腹腔镜肾切开取石术者54例（腹腔镜组），行PNL治疗72例（PNL组）。比较两组患者的手术相关情况及疗效指标。结果两组患者手术均顺利完成，无围手术期死亡病例。腹腔镜组的手术时间长于PNL组，但术中出血量小于PNL组，差异均有统计学意义（P〈0．05）。两组患者的住院时间和中转开放率比较，差异无统计学意义（P〉0．05）。腹腔镜组二期手术率高于PNL组，术中结石清除率低于PNL组，差异均有统计学意义（P〈0．05）。但两组术后并发症发生发生率比较，差异无统计学意义（P〉0．05）。经二期手术后，两组患者最终结石清除率均为100％。结论后腹腔镜肾切开取石术和PNL治疗复杂性肾结石均安全有效，后腹腔镜肾切开取石术的手术时间较长，手术出血量较少，结石残留率较高。

Objectives To compare the efficacy between retroperitoneal laparoscopic nephrolithotomy and percutaneous nephrolithotomy （PNL） in patients with complex renal calculi. Methods Clinical data for 126 patients with complex renal calculi from January2010 to December 2014 were reviewed. They were divided into laparoscopic group （n = 54 ） underwent retroperitoneal laparoscopic nephrolithotomy and PNL group （ n = 72） underwent PNL. The condition related to surgery and indexes for therapeutic effects between the two groups were compared. Results All of the patients underwent surgery successfully and no perioperative death occurred. In the laparoscopic group, operative time was longer than that in the PNL group（ P 〈0.05） ,and blood loss was less than that in the PNL group （ P 〈 0.05 ）. No difference in the hospital stay and rate of conversion between the two groups were found （ P 〉 0.05）. In the laparoscopic group, the rate of two - stage operation was higher than that in the PNL group （ P 〈 0.05 ） , and intraoperative stone - free rate was lower than that in the PNL group （ P 〈 0.05）. After two - stage operation, the postoperative stone - free rate was 100%. Conclusions Laparoscopic biliary tract surgery for choledocholithiasis in elderly patients is safe and effective. But surgeons should grasp the operation indication flexibly and optimize the perioperative management.