肾盏穿刺部位差异对微创经皮肾镜取石术治疗复杂性肾结石的影响

Influence of renal needle puncture site differences on stone removal effects,operation related clinical indicators and complications of patients with complicated renal calculi by minimally invasive percutaneous nephrolithotomy with lithotomy

目的:探讨肾盏穿刺部位差异对行微创经皮肾镜取石术(MPCNL)复杂性肾结石患者结石清除率、手术相关临床指标及并发症的影响。方法:研究对象选取2015年4月～2017年4月收治行MPCNL复杂性肾结石患者共150例,根据穿刺部位不同分为A组(50例)、B组(50例)及C组(50例),分别于肾上盏、肾中盏及肾下盏进行穿刺;比较三组患者术后48h和3个月结石清除率、通道建立时间、手术时间、Hb下降值、住院时间、多通道建立率及术后并发症发生率。结果:三组患者术后48h和3个月结石清除率比较差异无统计学意义(P>0.05);C组患者通道建立时间显著长于A、B组(P<0.05);三组患者手术时间、Hb下降值、住院时间及多通道建立率比较差异无统计学意义(P>0.05);三组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论:针对行MPCNL复杂性肾结石患者采用肾上盏、中盏及下盏穿刺在疗效及安全性方面较为接近;但行肾下盏穿刺可能导致穿刺时间延长。

Objective:To investigate the influence of renal needle puncture site differences on stone removal effects,operation related clinical indicators and complications of patients with complicated renal calculi by minimally invasive percutaneous nephrolithotomy with lithotomy(MPCNL).Methods:150 patients with complicated renal calculi treated by MPCNL were chosen in the period from April 2015 to April 2017 in our hospital and randomly divided into group A(n=50)subject to upper calyx puncture,group B(n=50)subject to middle calyx puncture,and group C(n=50)undergoing lower calyx puncture.The stone clearance rate in 48 hand 3 months after operation,the passageway establishment time,operation time,Hb decline amount,hospital stay,multichannel establishment rate and postoperative complication incidence in all groups were compared.Results:There was no significant difference in the stone clearance rate in 48 hand 3 months after operation among 3 groups(P<0.05).The passageway establishment time in group C was significantly longer than in groups A and B(P<0.05).There was no significant difference in the operation time,Hb decline amount,hospital stay time and multi-channel establishment rate among three groups(P<0.05).There was no significant difference in the postoperative complication incidence among three groups(P<0.05).Conclusions:Renal needle puncture in upper calyx,middle calyx and lower calyx applied on patients with complicated renal calculi treated by MPCNL possesses the same clinical effects and safety,but the renal needle puncture in the lower calyx may cause the longer puncture time.