经皮微肾镜钬激光治疗复杂性肾结石的临床效果及安全性评价

Clinical Efficacy and Safety Evaluation of Percutaneous Micronephroscopic Holmium Laser in Treatment of Complex Renal Calculi

目的:评价经皮微肾镜钬激光治疗复杂性肾结石的临床效果及安全性。方法:选取2014年10月-2016年10月在笔者所在医院进行治疗的132例复杂性肾结石患者作为研究对象。根据患者所接受取石手术分为MPCNL组(经皮微肾镜钬激光取石术,52例)、PCNL组(经皮肾镜取石术,49例)及开放组(开放手术,31例)。对比三组平均手术时间、术中出血量、术中并发症、结石清除率、术后并发症、术后尿液转清时间、住院时间,造瘘管放置时间。结果:MPCNL组手术时间短于PCNL组及开放组,术中出血量少于PCNL组及开放组,术中并发症发生率低于PCNL组及开放组,差异均有统计学意义(P<0.05),三组结石取净率比较差异无统计学意义(P>0.05)。MPCNL组尿液转清时间、术后住院时间、造瘘管留置时间均短于PCNL组及开放组,术后并发症发生率低于PCNL组及开放组,差异均有统计学意义(P<0.05)。术前三组血肌酐比较差异无统计学意义(P>0.05),术后24 h、48 h、7 d时MPCNL组血肌酐均低于开放组和PCNL组,差异均有统计学意义(P<0.05)。结论:与传统经皮肾镜取石术和开放手术相比,经皮微肾镜钬激光治疗复杂性肾结石可在保障结石清除效果的前提下显著减轻外科创伤及并发症,促进患者恢复。

Objective: To evaluate the clinical efficacy and safety of percutaneous micronephroscopic holmium laser in the treatment of complex renal calculi. Method: A total of 132 patients with complex renal stones treated in my hospital from October 2014 to October 2016 were selected as the subjects. According to the patients’ stone removal surgery, they were divided into the MPCNL(laser lithotomy with percutaneous micro-nephrolithotomy, 52 cases), the PCNL group(percutaneous nephrolithotomy, 49 cases) and the open group(open operation, 24 cases). The average operation time, intraoperative bleeding volume, intraoperative complications, stone clearance rate, postoperative complications, urine clearance time, hospital stay and fistula placement time were compared among the three groups. Result: The operation time, intraoperative bleeding volume and intraoperative complications in the MPCNL group were better than those in the PCNL group and the open group, the differences were statistically significant(P<0.05). There was no significant difference in stone removal rate among the three groups(P>0.05). The urine conversion time, postoperative hospitalization time and fistula indwelling time in the MPCNL group were shorter than those in the PCNL group and the open group, and the incidence of postoperative complications was lower than that in the PCNL group and the open group, the differences were statistically significant(P<0.05). There was no significant difference in serum creatinine among the three groups(P>0.05), the level of the MPCNL group was lower than that of the open group and the PCNL group at 24 h, 48 h and 7 d after operation, the differences were statistically significant(P<0.05). Conclusion: Compared with the traditional percutaneous nephrolithotomy and open surgery, the traditional percutaneous nephrolithotomy for treating the complicated kidney stones can significantly reduce the surgical trauma and the complications and promote the recovery of the patients under the premise of ensuring the removal effect of the stone.