既往手术史对经皮肾镜取石术的影响

Comparative analysis of percutaneous nephrolithotomy in patients with and without history of local surgery

目的探讨既往肾脏手术史对经皮肾镜取石术(PCNL)的影响。方法回顾分析2014年1月至2017年12月本院449例行PCNL患者的临床资料,将患者分为四组:既往开放手术组78例(A组),既往腹腔镜手术组38例(B组),既往PCNL组66例(C组),无外科干预史组267例(D组)。比较各组患者的总体手术时间、穿刺时间、碎石时间、多通道比例、结石清除率、二次碎石比例、并发症等指标的差异。结果A组患者较B、C、D组穿刺时间明显较长(P<0.05)。A组患者二次碎石比例较B、C、D组增高(P<0.05)。其余指标差异无统计学意义(各组数据均P>0.05)。结论探讨既往肾脏手术史对PCNL的影响不大,PCNL处理既往手术后肾结石是安全有效的治疗方案。

Objective To investigate the effects of previous local renal surgery,including open surgery laparoscopic surgery and percutaneous nephrolithotomy(PCNL),on the results of subsequent PCNL.Methods The clinical data of 449 patients with PCNL in our hospital from January 2014 to December 2017 were retrospectively analyzed.The patients were divided into four groups:78 patients were in the former open operation group(the group A),38 patients were in the former laparoscopic operation group(the group B),66 patients were in the former PCNL group(the group C)and 267 patients without history of surgical intervention(the group D).The differences of total operation time,puncture time,lithotripsy time,multi-channel ratio,stone clearance rate,secondary lithotripsy ratio and complications were compared among these groups.Results The puncture time of the group A was longer than that of group B,C and D(P<0.05).The proportion of secondary lithotripsy in the group A was higher than that of the group B,C and D(P<0.05).There was no significant difference in other indicators(P>0.05).Conclusion The history of previous kidney surgery has little effect on PCNL.PCNL is a safe and effective treatment for renal calculi after previous kidney surgery.