微创经皮肾镜碎石术治疗直径≤2 cm肾结石的临床研究

Clinical Study on Minimally Invasive Percutaneous Nephrolithotripsy in the Treatment of Renal Calculi with Diameter within 2 cm

目的探究微创经皮肾镜碎石术治疗直径≤2 cm肾结石的临床疗效和安全性。方法方便选取中国人民解放军第八二医院和淮安市淮阴医院泌尿外科2013年12月—2016年12月收治的60例肾结石患者按照手术方式不同分为观察组(n=38)和对照组(n=22)进行回顾性分析,观察组患者采用微创经皮肾镜碎石术治疗,对照组采用传统的开放式手术治疗,比较两组患者手术时间、术中出血量、住院时间、结石清除率和术后并发症发生情况。结果观察组手术时间、术中出血量和住院时间显著优于对照组[(48.66±13.12)min vs(110.23±24.88)min;(66.44±25.57)m L vs(128.58±42.55)m L;(6.17±1.11)d vs(12.65±3.54)d],差异有统计学意义(t=12.576 7,P=0.000 0;t=7.0823,P=0.000 0;t=10.483 6,P=0.000 0);观察组结石清除率(94.73%)显著高于对照组(77.27%),差异有统计学意义(χ~2=4.123 6,P=0.042 3);观察组术后并发症产生率(7.89%)显著低于对照组(36.36%),差异有统计学意义(χ~2=7.542 4,P=0.006 0)。结论微创经皮肾镜碎石术治疗直径≤2 cm肾结石手术时间短,术中出血少,住院时间短,结石清除效果好,术后并发症少,值得在临床上广泛推广。

Objective This paper tries to explore the clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy in the treatment of renal calculi whose diameter within 2 cm. Methods Convenient selection a total of 60 patients with renal calculi treated in the department of urology in No.82 Hospital of PLA and Huai'an Huaiyin Hospital from December 2013 to December 2016 were divided into the observation group(n=38) and the control group(n=22) according to different surgical methods, and then were retrospectively analyzed. The observation group was treated by minimally invasive percutaneous nephrolithotomy while the control group was treated by traditional open surgery. The surgical time,intraoperative blood loss, hospitalization time, calculi clearance rate and the incidence of complications after surgery were compared between the two groups. Results The surgical time, intraoperative blood loss and hospitalization time of the observation group were significantly better than the control group [(48.66 ±13.12)min vs(110.23 ±24.88)min;(66.44±25.57)m L vs(128.58±42.55)m L;(6.17±1.11)d vs(12.65±3.54)d], the difference was statistically significant(t=12.576 7, P=0.000 0; t=7.082 3, P=0.000 0; t=10.483 6, P=0.000 0). The calculi clearance rate in the observation group was 94.73%, significantly higher than that in the control group of 77.27%, the difference was significant(χ~2=4.123 6, P=0.042 3). The incidence of complications in the observation group after surgery was 7.89%, significantly lower than that in the control group of 36.36%,the difference was significant(χ~2=7.542 4,P =0.006 0). Conclusion The application of minimally invasive percutaneous nephrolithotomy in treatment of renal calculi with diameter within 2 cm can shorten the surgical time, reduce intraoperative blood loss and shorten hospitalization time, with remarkable calculi removal effect and fewer complications. Therefore it is worth clinical application.