MPCNL治疗简单和复杂肾结石的回顾性比较研究  

A retrospective comparative study of minimally invasive percutaneous nephrolithotomy in the treatment of simple and complex renal caliceal stones

作　　者：杨璧铖[1] 赵志健[1] 钟文[1] 麦赞林[1] 吴文起[1] 袁坚[1] 曾国华[1] 

机构地区：[1]广州医科大学附属第一医院微创外科中心泌尿外科广东省泌尿外科重点实验室,广州510000

出　　处：《微创泌尿外科杂志》2013年第5期331-333,共3页Journal of Minimally Invasive Urology

基　　金：国家自然科学基金面上项目(81170652)

摘　　要：目的:比较研究经皮肾镜取石术(MPCNL)治疗简单和复杂肾结石的安全性和有效性.方法:回顾分析MPCNL治疗5 761例(41.2%)简单肾结石和8 223例(58.8%)复杂肾结石的临床资料,对其安全性及有效性进行比较研究.结果:复杂性结石患者结石较大(1 763.0 ∶1 018.6 mm2,P＜0.05).简单肾结石患者手术时间较短(72.4~28.4∶90.4~41.9 min,P＜0.001),更少使用多通道取石(1.9%∶20.7%,P＜0.001),血红蛋白下降较少(12.3±10.7∶14.4±11.6)g/L,(P＜0.001).在患者接受的首次取石术中,简单肾结石获得更高的结石清除率(77.6%∶66.4%,P＜0.05).但患者在接受二期手术治疗后简单肾结石和复杂肾结石患者的结石清除率差异无统计学意义(81.3%∶80.1%,P＞0.05).两组的并发症发生率(25.17%∶26.32%,P＞0.05)和输血率(2.2%∶3.2%,P＞0.05)差异无统计学意义.但在复杂肾结石中,肾血管栓塞较简单肾结石多(0.28%∶0.67%,P＜0.05).结论:MPCNL是治疗复杂肾结石安全有效的术式,两组结石清除率无差异,但复杂结石组手术时间长,所需通道多,且出血栓塞更多.Objective:To compare the safety and effectiveness of MPCNL in the treatment of simple and complex renal caliceal stones.Methods:5 761(41.2%)simple caliceal stones and 8 223(58.8%)complex caliceal stones managed by MPCNL were retrospectively investigated.Results:Larger stone burden was observed in complex stones(1 763.0∶1 018.6mm2,P<0.05).Shorter operative time(72.4-28.4∶90.4-41.9,P<0.001),less multiple percutaneous accesses(1.9%∶20.7%,P<0.001),and less change in hemoglobin levels(12.3±10.7∶14.4± 11.6g/L,P<0.001)were gained in patients bearing simple stones.Though complex stones had a lower stone-free rate for the initial session of MPCNL(77.6%∶66.4%,P<0.05),no significant difference was found after secondary procedure(81.3%∶80.1%,P>0.05).The complication rate(25.17%∶26.32%,P>0.05)and blood transfusion rate(2.2%∶3.2%,P>0.05)showed no significant difference in both groups.But the renal vascular embolizaitons appeared to be higher in complex stones(0.28%∶0.67%,P<0.05).Conclusions:MPCNL serves as a reasonable option for complex caliceal stone patients with its safety and effectiveness.The lower initial stone free rate in patients with complex caliceal stones diminished with secondary procedures.

关 键 词：微创经皮肾镜 肾结石 

分 类 号：R692[医药卫生—泌尿科学]