腹腔镜治疗肾盏憩室结石与经皮肾镜治疗憩室结石的对比

Comparative caliceal diverticular calculi between laparoscopic treatment and percutaneous nephrolithotomy treatment

目的 对比腹腔镜治疗肾憩室结石和经皮肾镜治疗憩室结石的临床疗效。方法 采用回顾性研究的方法,选取2009年6月至2015年3月52例肾盏憩室结石患者,腹腔镜治疗的患者24例,经皮肾镜治疗患者28例,观察两组患者治疗效果、并发症及术后随访结果。结果 用腹腔镜治疗肾憩室结石中,有1例患者改为开放手术,其余均成功;经皮肾镜下治疗方法均取得成功。术中的手术时间,术中出血量,术后疼痛分数及术后住院时间方面,经皮肾镜明显优于腹腔镜,差异均有统计学意义(P<0.05)。而结石清除率方面,腹腔镜明显优于经皮肾镜,差异有统计学意义(P<0.05),并发症如术后出血,发热,感染性休克,漏尿无统计学意义(P>0.05),随访结果:两者术后均无腰痛、血尿、泌尿系感,术后6个月复查静脉尿路造影,未见结石复发。结论 经皮肾镜治疗肾憩室结石具有手术时间短、术中出血量少、住院时间短且恢复快的疗效,但结石清除率较腹腔镜低,对于同时肾切开取石术、基础解剖异常明确的及结石直径>3厘米的,还是优先考虑腹腔镜的方法。

Objective Clinical efficacy of percutaneous nephrolithotomy treatment of caliceal diverticular calculi contrast laparoscopic treatment.Methods A retrospective study of methods,52 cases of kidney stones in patients with diverticular calyx are selected in June 2009 to March 2015,laparoscopic treatment of 24 patients,percutaneous nephrolithotomy treatment of 28 patients,the groups were observed treatment effect,complications and postoperative follow-up results.Results One patient in the laparoscopic treatment of caliceal diverticular calculi switch to open surgery,the rest were successful;percutaneous nephrolithotomy treatment methods are successful.Intraoperative operative time,blood loss,postoperative pain scores and postoperative hospital stay,percutaneous nephrolithotomy significantly is better than laparoscopy,the differences was statistically significant(P<0.05).The stone clearance rate,laparoscopic treatment is much better than percutaneous nephrolithotomy,the differences was statistically significant(P<0.05),postoperative complications such as bleeding,fever,septic shock,leak are no significant difference(P>0.05).follow-up results:both groups were no postoperative back pain,hematuria,urinary system sense,intravenous urography would be inspected after 6 months,no stone recurrence.Conclusion Percutaneous nephrolithotomy treatment of Caliceal diverticular calculi has shorter operative time,less blood loss,shorter hospital stay and faster recovery effect,but the stone clearance rate lower than the laparoscopy,but for simultaneous kidney lithotomy,basic anatomical abnormalities and stone diameter>3 cm,we should give priority to the laparoscopic approach.