一步扩张法与逐级扩张法建立微通道在经皮肾镜碎石术中的应用比较

The comparison between one step expanding method and gradual expandingmethod of establishing microchannel in percutaneous nephrolithotomy

目的比较一步扩张法与逐级扩张法建立微通道在经皮肾镜碎石术中的应用效果。方法 58例肾结石患者,根据入院顺序进行分组,奇数为观察组,偶数为对照组,每组各29例。两组均采用经皮肾镜碎石术治疗,其中观察组在建立微通道时采用的是一步扩张法,对照组采用逐级扩张法,比较两组手术时间、术中出血量、结石清除情况及术后并发症发生情况,同时评价两组入院时及出院时的生活质量。结果观察组手术时间明显短于对照组(P<0.01),两组术中出血量、结石一期清除率比较差异无统计学意义(P>0.05)。观察组并发症发生率为7.94%,显著低于对照组的22.22%(P<0.01)。两组出院时生活质量各维度评分均有显著上升(P<0.01),但观察组上升更明显(P<0.05)。结论在经皮肾镜碎石术中采用一步扩张法建立微通道相对于逐级扩张法能有效简化手术操作程序,缩短手术时间,同时减少手术并发症的发生,安全性高。

Objective To compare the effects of one step expanding method and gradual expanding method of establishing microchannel in percutaneous nephrolithotomy. Methods 58 cases of patients with calculus of kidney were divided into two groups according to their hospital admission sequence, each with 29 cases. Cases of odd number formed the observation group and those of even number formed the control group. Both of the groups were given percutaneous nephrolithotomy. One step expanding method was adopted when building microchannel in the observation group while gradual expending method was applied when building microchannel in the control group.The operation time, intraoperative blood loss, elimination rates of calculus as well as postoperative complications between the two groups were compared,and life quality of all cases on admission and at discharge was assessed. Results The operation time of the observation group was significantly shorter than that of the control group(P < 0.01),while the intraoperative blood loss and elimination rates of the groups were no difference( P > 0. 05). The incidence rate of complications of the observation group was 7. 94%,remarkable lower than22. 22% of the control group(P <0. 01). An increase was found obvious in terms of life quality at discharge, compared with that on admission(P < 0. 01), but the observation group increased significantly(P < 0. 05). Conclusions Compared with gradual expanding method,one-step expanding method of establishing microchannel in percutaneous nephrolithotomy can simplify the operative procedure,shorten the operation time,reduce the incidence of complication and higher safety.