多通道与单通道经皮肾镜取石术联合输尿管软镜治疗复杂性肾结石

Comparative study of multi-channel and single-channel minimally invasive percutaneous nephrolithotomy combined with ureteral soft mirror in the treatment of complex renal calculi

目的探讨多通道与单通道微创经皮肾镜取石术(PCNL)联合输尿管软镜(RIRS)治疗复杂性肾结石患者的临床疗效。方法选取我院2015年1月~2016年12月收治的复杂性肾结石患者76例,根据患者入院治疗时间顺序交叉将患者分为对照组及观察组,每组均为38例。对照组采用单通道经皮肾镜取石术联合RIRS进行取石治疗,观察组采用多通道经皮肾镜取石术联合RIRS进行取石治疗,比较两组患者的临床疗效。结果观察组术中出血量、手术时间、住院时间均高于对照组(P<0.05);观察组术后血红蛋白下降值大于对照组(P<0.05);观察组术后1天血肌酐水平明显高于对照组,较手术前呈现上升趋势(P<0.05);观察组一期术后结石清除率明显优于对照组(P<0.05);观察组一期术后平均残留结石直径低于对照组(P<0.05);两组二期术后结石清除率、残留结石直径及手术后并发症发生率比较差异均无统计学意义(P>0.05)。结论多通道或单通道经皮肾镜取石术联合输尿管软镜均能安全有效的治疗复杂性肾结石,多通道经皮肾镜取石术联合输尿管软镜一期结石清除率高于单通道联合输尿管软镜术,但单通道联合输尿管软镜术减少术中出血量及缩短患者住院时间具有一定优势,临床可根据患者个人需求选择相应手术方案治疗复杂性肾结石。

Objective To evaluate the clinical efficacy of minimally invasive percutaneous nephrolithotomy （PCNL） combined with single channel minimally invasive percutaneous nephrolithotomy （RIRS） in the treatment of complicated renal calculi. Methods Methods 76 patients with complex renal calculi admitted in our hospital from January 2015 to 2016 were selected and divided into the control group and the observation group according to the time of admission, and each group of patients with 38 cases. Patients in the control group were treated with single channel minimally invasive percutaneous nephrolithotomy combined with RIRS, and the patients in the observation group were treated with minimal ly invasive percutaneous nephrolithotomy combined with RIRS. The clinical efficacy of the two groups was compared. Results The bleeding volume, operation time and hospitalization time of observation group were higher than that of the control group （P〈0.05）. The decreasement of hemoglobin of observation group were greater than that in the control group （P〈0.05）. The serum creatinine level of observation group was significantly higher than that the control group （P〈0.05）. The period of postoperative stone clearance rate of observation group （81.57%） was significantly higher than the control group （52.63%） （P〈0.05）. The postoperative residual stone diameter of observation group was lower than that of the control group （P〈0.05）. The postoperative stone clearance rate, residual stone diameter had no signifi- cant difference between the two groups （P〈0.05）. The postoperative complications between the two groups were no sig nificant difference （P〉0.05）. Conclusion Multi channel or single channel of minimally invasive percutaneous nephro- lithotomy combined ureteroscope is safe and effective in the treatment of complicated renal calculi. The minimally invasive percutaneous nephrolithotomy combined ureteroscope a stone clearance rate is higher than that of single channel and flexi- ble ureteroscope operation, but the single channel combined with flexible ureteroscopy reduce the amount of bleeding has certain advantages and shorten the hospitalization time.