肾结石≥2 cm患者个体化手术分析

Analysis of individual operation for patients with renal calculi ≥2 cm

目的分析肾结石≥2 cm患者个体化手术效果,为临床术式选择提供可靠依据。方法 80例肾结石患者根据实际情况进行个体化手术治疗,包括开放手术17例、体外冲击波碎石术(ESWL)18例、经皮肾镜取石术(PCNL)20例、输尿管软镜碎石术(FURS)25例。统计80例患者不同手术方法碎石成功率及总碎石成功率,术后1个月内结石排净率,手术并发症及术后肾功能改善效果。结果80例患者中,开放手术、ESWL、PCNL、FURS碎石成功率依次为88.24%、88.89%、95.00%、96.00%,总碎石成功率为92.50%,术后1个月内结石排净率为93.75%;术后并发症发生率依次为35.29%、16.67%、15.00%、8.00%,总发生率为17.50%,主要包括尿道口渗血、漏尿、疼痛剧烈、尿路感染、结石移入肾内。80例患者术后血清肌酐(SCr)、血尿素氮(BUN)、免疫球蛋白G(Ig G)均较术前显著降低(P<0.05)。结论针对肾结石≥2 cm患者实际情况个体化选择开放手术、ESWL、PCNL、FURS治疗,均可取得满意的效果,从手术效果及安全性方面考虑,建议优先选择PCNL、FURS。

To analyze the individual operation effects of patients with renal calculi≥2 cm in order to provide a reliable basis for clinical surgical method choice.Eighty patients with renal calculi eligible for the request from July 2015 to July 2017 were enrolled in the study and treated with individual operation according to the actual situation.The individual operations included 17 cases of open surgery,18 cases of extracorporeal shock wave lithotripsy(ESWL),20 cases of percutaneous nephrolithotomy(PCNL)and 25 cases of flexible ureteroscope lithotripsy(FURS).The success rate of lithotripsy and total success rate of lithotripsy by different operation methods in the 80 patients,the stone removal rate within 1 month after operation,the operation complications and the improvement of postoperative renal function were recorded.In the 80 patients,the success rates of lithotripsy by open surgery,ESWL,PCNL and FURS were 88.24%,88.89%,95.00%and 96.00%,respectively,and the total success rate of lithotripsy was 92.50%,and the stone removal rate was 93.75%within 1 month after operation.The incidence of postoperative complications were 35.29%,16.67%,15.00%and 8.00%with the total incidence rate of 17.50%,mainly including urethral bleeding,leakage of urine,severe pain,urinary tract infection,and stones shift into the kidney.The levels of serum creatinine(SCr),blood urea nitrogen(BUN)and immunoglobulin G(IgG)were significantly lower after operation than before operation(P<0.05).The individual operation methods in patients with renal calculi≥2 cm are chosen from open surgery,ESWL,PCNL and FURS according to the actual situation,and all can achieve satisfactory effects.However,it is suggested that PCNL and FURS should be taken as priority selection from the aspects of surgical effect and safety.