标准通道与微通道经皮肾镜治疗感染性肾结石的对比研究  

A comparative study of standard percutaneous nephrolithotomy and Min - percutaneous nephrolithotomy in treatment of renal struvite calculi

作　　者：张林林[1] 吴卫真[1] 朱李兵[1] 朱凌峰[1] 王栋[1] 谢星[1] 林若飞[1] 

机构地区：[1]福建医科大学福总临床医学院泌尿外科,福州350025

出　　处：《临床外科杂志》2011年第2期121-124,共4页Journal of Clinical Surgery

摘　　要：目的研究经皮肾镜标准通道与微通道碎石术治疗感染性肾结石疗效和安全性。方法回顾分析2006年1月至2010年6月我院138例（149例次）应用经皮肾镜术治疗肾脏感染性结石患者的资料。其中采用标准通道83例次，采用微通道66例次。对两组患者结石清除率、手术时间和手术并发症等指标进行比较分析。结果两组患者均分别成功建立24F和18F肾穿刺通道。两组清石率比较：标准通道组与微通道组I期单通道结石清除率分别为71．08％（59／83）、48．48％（32／66），P〈0．05；I期结石总清除率分别为80．72％（67／83）、60．60％（40／66），P〈0．05；两组的手术时间分别为（95±16）min和（120±15）min，P〈0．05。术后并发症方面：两组术中出血量分别为（136±9．6）ml、（139±8．9）ml，P〉0．05；两组术后血细菌培养阳性分别为18例、24例，P〈0．05；两组术后发热（体温〉39℃）分别为10例、13例，P〉0．05。结论标准通道经皮肾镜术具有手术时间短、清石效率高、低压灌注及感染率低，术后菌血症发生率低等优点，在处理感染性肾结石方面优于微小通道经皮肾镜术。Objective To compare the efficacy and safety of standard percutaneous nephrolithoto- my（ S - PCNL） and Min - percutaneous nephrolithotomy（ MI - PCNL） in the treatment of renal struvite calculi. Methods Clinical data of 138 patients with renal struvite calculi who underwent PCNL from January 2006 to June 2010 in our hospital were retrospectively analyzed. S - PCNL and MI - PCNL were performed in 83 and 66 cases respectively. Stone - free rate, operative time and complications were compared. Results 24F and 18F percutaneous renal assess were successfully established in the S - PCNL and MI - PCNL groups respectively. The single channel stone - free rate at phase I was 71.08% （59/83） in the S - PCNL group and 48.48% （ 32/66 ） in the MI - PCNL group with difference being significant（ P 〈 0.05 ）. The total stonefree rate at phase I was 80.72% （67/83）in the S -PCNL group and 60.60% （40/66）in the MI- PCNL group（ P 〈 0.05 ）. The operative time was（95 ± 16）min in the S- PCNL group and（ 120 ± 15 ）min in the MI -PCNL group（ P 〈 0.05 ）. Mean blood loss in the operation was（ 136 ± 9.6 ）ml in the S - PCNL group and（ 139 ±8.9 ） ml in the MI - PCNL group （ P 〉 0.05 ）. Hemocuhure examination re- vealed that positive results appeared in 18 patients in the S - PCNL group and 24 patients in the MI - PC- NL group（P 〈0.05）. Ten patients in the S - PCNL group and 3 patients in the MI - PCNL group devel- oped high fever（Temperature 〉 39.0℃ ） after the operation （P 〉 0.05 ）. Conclusion S - PCNL is superior to MI -PCNL in the treatment of renal struvite calculi in terms of operative time, stone -free rate, infection rate and incidence of bacteremia after operation.

关 键 词：肾结石 经皮肾镜取石术 

分 类 号：R692.4[医药卫生—泌尿科学]