经皮肾镜碎石取石术中不同穿刺目标肾盏治疗铸型肾结石的效果比较

The efficacy comparison of percutaneous nephrolithotomy with different puncture targets of renal calices in the treatment of renal staghorn calculus

目的比较经皮肾镜碎石取石术(PCNL)中不同穿刺目标肾盏治疗铸型肾结石的疗效差异。方法407例铸型肾结石患者,按照穿刺路径不同分为上盏后组穿刺组(138例)、中盏后组穿刺组(157例)和下盏后组穿刺组(112例)。比较三组一期结石清除率、手术时间、血红蛋白减少量、不良事件发生率。结果上盏后组穿刺组手术时间、血红蛋白减少量分别为(81.3±12.2)min、(10.5±6.0)g/L,中盏后组穿刺组手术时间、血红蛋白减少量分别为(92.4±9.7)min、(11.3±5.5)g/L,下盏后组穿刺组手术时间、血红蛋白减少量分别为(110.7±16.5)min、(22.1±10.2)g/L;上盏后组穿刺组和中盏后组穿刺组手术时间、血红蛋白减少量均优于下盏后组穿刺组,差异有统计学意义(P<0.05);上盏后组穿刺组血红蛋白减少量与中盏后组穿刺组比较,差异无统计学意义(P>0.05);上盏后组穿刺组手术时间优于中盏后组穿刺组,差异有统计学意义(P<0.05)。上盏后组穿刺组和中盏后组穿刺组一期结石清除率高于下盏后组穿刺组,差异有统计学意义(χ^2=5.120、6.357,P<0.05);上盏后组穿刺组一期结石清除率与中盏后组穿刺组比较,差异无统计学意义(χ^2=0.036,P>0.05)。中盏后组穿刺组不良事件发生率低于上盏后组穿刺组和下盏后组穿刺组,差异有统计学意义(χ^2=4.476、5.563,P<0.05);上盏后组穿刺组不良事件发生率低于下盏后组穿刺组,差异有统计学意义(χ^2=5.563,P<0.05)。结论对于铸型肾结石患者采用经皮肾镜碎石取石术治疗,穿刺上盏或中盏通道安全可靠且结石清除率较高。

Objective To compare the efficacy difference of percutaneous nephrolithotomy(PCNL)with different puncture targets of renal calices in the treatment of renal staghorn calculus.Methods A total of 407 patients with renal staghorn calculus were divided into upper calices group(138 cases),middle calices group(157 cases)and lower calices group(112 cases)by different puncture pathways.The one-stage calculus clearance rate,operation time,hemoglobin reduction and incidence of adverse events of the three groups was compared.Results The operation time and hemoglobin reduction of upper calices group was(81.3±12.2)min and(10.5±6.0)g/L,which was(92.4±9.7)min and(11.3±5.5)g/L of middle calices group,and(110.7±16.5)min and(22.1±10.2)g/L of lower calices group.The operation time and hemoglobin reduction of upper calices group and middle calices group was better than that of lower calices group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in hemoglobin reduction between upper calices group and middle calices group(P>0.05).The operation time of upper calices group was better than that of middle calices group,and the difference was statistically significant(P<0.05).The one-stage calculus clearance rate of upper calices group and middle calices group was higher than that of lower calices group,and the difference was statistically significant(χ^2=5.120,6.357,P<0.05).The one-stage calculus clearance rate of upper calices group had no statistically significant difference compared with that of middle calices group(χ^2=0.036,P>0.05).The incidence of adverse events of middle calices group was lower than that of upper calices group and lower calices group,and the difference was statistically significant(χ^2=4.476,5.563,P<0.05).The incidence of adverse events of upper calices group was lower than that of lower calices group,and the difference was statistically significant(χ^2=5.563,P<0.05).Conclusion For patients with renal staghorn calculus,percutaneous nephrolithotomy with upper or middle calices puncture is safe and reliable,and the calculus clearance rate is high.