30F大通道经皮肾镜钬激光碎石取石术不留置造瘘管治疗肾鹿角结石的疗效观察

Clinical Effect of 30F Large Channel Percutaneous Nephrolithotomy with Holmium Laser Litho-tripsy without Detaining Renal Fistulas for the Treatment of Staghorn Calculi

【目的】探讨30F大通道经皮肾镜钬激光碎石取石术不留置肾造瘘管治疗肾鹿角结石的临床效果。【方法】选取2013年4月至2016年11月本院收治的60例肾鹿角结石患者的临床资料，根据随机数表法将其分为观察组和对照组，每组各30例。对照组给予腹腔镜取石术，观察组采用30F大通道经皮肾镜狄激光碎石进行取石，且术后不留置肾造瘘管。观察记录两组患者术中出血量、手术时间、住院天数及疼痛评分；两组均随访1个月，比较两组患者术后的血肌酐（SCr）、肾小球滤过率（GFR）水平及术后并发症发生情况及两组患者结石的清除率。【结果】观察组手术时间、术中出血量、住院天数以及疼痛评分均低于对照组，差异均具有统计学意义（P〈0．05）。两组术前SCr、GFR水平比较，差异无统计学意义（P〉0．05）；术后观察组SCr水平明显低于对照组，GFR水平高于对照组，差异均具有统计学意义（P〈0．05）。观察组结石清除率为93．33％（28／30）显著高于对照组的66．67％（20／30），差异具有统计学意义（X^2=6．668，P=0．009〈0．05）。观察组术后并发症总发生率为6．67％（4／30），显著低于对照组的46．67％（14／30），差异具有统计学意义（X^2=7．937，P=0．005〈0．05）。【结论】30F大通道经皮肾镜钬激光碎石取石术不留置造瘘管治疗肾鹿角结石安全有效，具有创伤小、结石清除率高、并发症少的优点，对患者肾功能损害程度低，值得临床推广和应用。

[Objective]To investigate the clinical effect of 30F large channel percutaneous nephrolithotomy with holmium laser lithotripsy without detaining renal fistulas for the treatment of staghorn calculi.[Methods] From April 2013 to November 2016, 60 patients with renal staghorn calculi were divided into observation group and control group with 30 cases in each group. The control group was treated with laparoscopic lithotrip- sy, the observation group was treated with 30 F large channel percutaneous nephrolithotripsy, and there was no indwelling nephrostomy tube after operation. Blood loss, operation time, hospital stay and pain score were recorded in both groups, and all patients were followed up for 1 month. Serum creatinine （SCR）, glomerular filtration rate （GFR） and postoperative complications were compared between the two groups.[Results]The operative time, intraoperative bleeding volume, hospitalization clays and pain score in the observation group were significantly lower than those in the control group （ P〈0.05）. There was no significant difference in SCr,GFR between the two groups before operation （ P 〉0.05）, but the level of SCr in the observation group was significantly lower than that in the control group （ P 〈0.05）, and the level of GFR in the observation group was significantly lower than that in the control group （ P〈0.05）. The stone clearance rate was 93.33% （28/30） in the observation group and 66.67% （20/30） in the control group. The difference was statistically significant （X^2 = 6.668, P=0.009〈0.05） 〈0.05）. The total incidence of postoperative complications in the observation group was 6.67% （4/30）, which was significantly lower than that in the control group （46.67%, 14 / 30）. The difference was statistically significant （X^2 = 7. 937, P = 0. 005 〈 0.05）. [Conclusion] 30F large channel percutaneous nephrolithotomy with holmium laser lithotripsy without detaining renal fistulas for the treatment of staghorn calculi is safe and effective. It has the advantages of less trauma, high stone clearance rate and fewer complications. It has low damage to renal function and is worthy of clinical promotion and appli- cation.