经皮肾镜取石术与后腹腔镜肾盂切开取石术治疗肾盂结石疗效比较

Comparison of the effect between percutaneous nephrolithotomy and retroperitoneal laparoscopic pyelolithotomy in the treatment of renal pelvis calculus

目的比较经皮肾镜取石术(PCNL)和后腹腔镜肾盂切开取石术(RLP)治疗肾盂结石的临床效果,为选择肾盂结石治疗方法提供依据。方法选取2012年1月至2016年12月驻马店市中心医院收治的肾盂结石患者108例,根据治疗方法将患者分为PCNL组(n=59)和RLP组(n=49),对2组患者的手术时间、术中失血量、术中输血率、手术成功率、结石清除率、术后血红蛋白降低值、术后镇痛时间、术后住院时间及并发症发生率进行比较。结果 PCNL组和RLP组患者手术成功率分别为94.9%(56/59)、100.0%(49/49),2组患者手术成功率比较差异无统计学意义(χ~2=1.026,P>0.05)。PCNL组和RLP组患者结石完全清除率分别为94.9%(56/59)、98.0%(48/49),2组患者结石完全清除率比较差异无统计学意义(χ~2=0.140,P>0.05)。PCNL组和RLP组患者术中输血率分别为5.1%(3/59)、2.0%(1/49),2组患者术中输血率比较差异无统计学意义(χ~2=0.105,P>0.05)。2组患者手术时间、术后镇痛时间比较差异均无统计学意义(P>0.05)。与PCNL组比较,RLP组患者术中失血量及术后血红蛋白水平降低少,术后住院时间短(P<0.05)。PCNL组患者术后尿漏、泌尿系统感染及继发性出血发生率分别为3.4%(2/59)、8.5%(5/59)、6.8%(4/59),RLP组患者术后尿漏、泌尿系统感染及继发性出血发生率分别为8.2%(4/49)、4.1%(2/49)、4.1%(2/49),2组患者术后尿漏、泌尿系统感染及继发性出血发生率比较差异均无统计学意义(χ~2=2.975、1.064、1.811,P>0.05)。结论 PCNL和RLP治疗肾盂结石的临床效果相当,且安全性较高;但RLP术中出血量少,患者术后恢复快、住院时间短。

Objective To compare the clinical effect between percutaneous nephrolithotomy( PCNL) and retroperitoneal laparoscopic pyelolithotomy( RLP) in the treatment of renal pelvis calculus,so as to provide evidence for the treatment of renal pelvis calculus. Methods A total of 108 patients with renal pelvis calculus were selected from January 2012 to December 2016 in Zhumadian Central Hospital. The patients were divided into PCNL group( n = 59) and RLP group( n = 49) according to the therapeutic method. The operation time,intraoperative blood loss,intraoperative blood transfusion rate,operative success rate,stone clearance rate,postoperative hemoglobin reduction,postoperative analgesia time,postoperative hospitalization time and the incidence of complications were compared between the two groups. Results The success rate of operation in PCNL group and RLP group was 94. 9%( 56/59) and 100. 0%( 49/49) respectively,there was no significant difference in the success rate of operation between the two groups( χ~2= 1. 026,P > 0. 05). The stone clearance rate in PCNL group and RLP group was 94. 9%( 56/59) and 98. 0%( 48/49) respectively,there was no significant difference in the stone clearance rate between the two groups( χ~2= 0. 140,P > 0. 05). The intraoperative blood transfusion rate in PCNL group and RLP group was 5. 1%( 3/59) and 2. 0%( 1/49) respectively,there was no significant difference in the intraoperative blood transfusion rate between the two groups( χ~2= 0. 105,P > 0. 05). There was no significant difference in operation time and postoperative analgesia time between the two groups( P > 0. 05). Compared with the PCNL group,the blood loss and postoperative hemoglobin reduction were less,and the postoperative hospitalization time was shorter in the RLP group( P < 0. 05). The incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage in PCNL group was 3. 4%( 2/59),8. 5%( 5/59)and 6. 8%( 4/59) respectively; the incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage in RLP group was 8. 2%( 4/49),4. 1%( 2/49) and 4. 1%( 2/49) respectively; there was no significant difference in the incidence of postoperative urinary leakage,urinary tract infection and secondary hemorrhage between the two groups( χ~2=2. 975,1. 064,1. 811; P > 0. 05). Conclusion The clinical effect of PCNL and RLP in the treatment of renal pelvis calculus is fairly,and their safety is high. However,RLP has the advantages of less intraoperative bleeding,quick postoperative recovery and short hospitalization time.