可视针形穿刺碎石一体镜联合尿石通治疗直径<1.5 cm肾结石临床分析

Study on the treatment of renal calculi by visual needle puncture lithotripsy integrated nephroscope combined with Niaoshitong

目的探讨4.8F可视针形穿刺碎石一体镜联合尿石通治疗直径<1. 5 cm肾结石的疗效及应用体会。方法直径<1.5 cm肾结石病人43例,采用4. 8F可视针形穿刺碎石一体镜钬激光碎石术治疗。按是否服用尿石通分为两组:观察组(22例)术后口服尿石通、饮水量2500 ml/d;对照组(21例)术后饮水量2500 ml/d。比较两组病人术后3个月内无石率及结石排净时间。结果观察组病人术后第1个月无石率为95. 5%(21/22例),对照组为71. 4%(15/21例),差异有统计学意义(P <0. 05),观察组第2个月复查时结石均已排净,对照组第2个月为90. 5%(19/21例)、第3个月为100%(21/21例),两组比较差异无统计学意义。观察组病人术后的结石排净时间为(1. 05±0. 21)个月,对照组为(1. 38±0. 67)个月,差异有统计学意义(P <0. 05)。结论 4. 8F可视针形穿刺碎石一体镜钬激光碎石可有效粉碎直径<1. 5 cm肾结石,尿石通可促进术后残余结石排出,二者联合使用具有一定的临床运用价值。

Objective To investigate the efficacy and application of holmium laser lithotripsy with 4. 8 F visual needle puncture lithotripsy combined with Niaoshitong in the treatment of < 1. 5 cm renal calculi. Methods A retrospective analysis was made of the clinical data of 43 patients with renal calculi < 1. 5 cm treated by 4. 8 F visual needle puncture lithotripsy combined with holmium laser lithotripsy. The observation group received oral urolithotripsy and water 2500 ml/day after operation,and the control group received water 2500 ml/day after operation. The stone-free rate and stone-free time of the two groups within 3 months after operation were compared. Results There was no significant difference in age,sex and stone size between the two groups( P > 0. 05). The stone-free rate of the observation group was 95. 5%(21/22) in the first month after operation,compared with 71. 4%(15/21) in the control group(P < 0. 05). The stones in the observation group were cleared at the second month of reexamination,and90. 5%(19/21) in the second month and 100% in the third month of the control group. There was no statistical difference between the two groups(21/21). The stone clearance time in the observation group was(1. 05 ± 0. 21)months,which was shorter than that in the control group(1. 38 ± 0. 67)months,with statistical significance( P < 0. 05). Conclusions 4. 8 F visual needle puncture lithotripsy combined with holmium laser lithotripsy can effectively comminute kidney stones less than 1. 5 cm. Urolithotripsy can promote the excretion of residual stones after operation. The combination of the two methods has certain clinical application value.