经皮肾镜取石术治疗多次体外冲击波碎石失败肾结石的临床分析  

Clinical evaluation of percutaneous nephrolithotomy in the treatment of renal stone after repeatedextracorporeal shockwave lithotripsy

作　　者：钟文[1,2] 曾国华[2] 袁坚[2] 单炽昌[2] 钟惟德[1,3] 

机构地区：[1]南方医科大学研究生学院,广州510515 [2]广州医学院第一附属医院、微创外科中心泌尿外科广东省泌尿外科重点实验室,广州510515 [3]广州市第一人民医院泌尿外科,广州510515

出　　处：《中华泌尿外科杂志》2013年第5期333-336,共4页Chinese Journal of Urology

摘　　要：目的探讨既往多次ESWL失败的肾结石患者行PCNL治疗的效果及并发症发生情况。方法2010年2月至2011年2月收治的44例多次ESWL治疗失败的肾结石患者（治疗组）与同期50例无手术治疗史的肾结石患者（对照组）接受PCNL治疗，对比分析两组手术治疗结果。结果治疗组与对照组建立经皮肾通道的时间分别为（11．8±4．1）、（10．9±2．5）min，差异无统计学意义（P〉0．05）；两组碎石取石时间分别为（92．0±13．5）、（66．6±17．6）min，手术时间分别为（113．9±12．0）、（87．6．4-13．6）min，组间差异均有统计学意义（P=0．000）。术后治疗组结石清除率81．8％，对照组94．O％，组间差异无统计学意义（P=0．067）。两组均无死亡等严重并发症发生。结论尽管反复ESWL失败后的肾结石患者较未接受ESWL治疗者PCNL碎石及总体手术时间延长，但结石清除率及手术并发症方面无统计学差异，因而PCNL治疗反复ESWL失败的肾结石是安全有效的。Objective To evaluate the effects and complications of percutaneous nephrolithotomy （PCNL） in the treatment of renal stone after repeated extracorporeal shockwave lithotripsy （ESWL）. Methods Forty-four patients who had a history of repeated ESWL （treatment group） and 50 patients with- out surgical intervention （control group） were submited to PCNL, and clinical data was documented in de- tails and analyzed. Results The time to establish access in treatment group and control group was （ 11.8 ±4.1 ） rain and （ 10.9 ± 2.5 ） rain, respectively, and there was no significant difference （ t = 1. 308, P =0. 194）. The time to extract stone in both groups was （92.0 ± 13.5） min and （66.6 ± 17.6） rain, re- spectively, and there was significant difference （ t = 7. 776, P = 0. 000）. The operative time in treatment group was （ 113.9± 12.0） min, which was longer than that in control group with （87.6 ± 13.6） min （t = 8.354, P =0.000）. The clearance in both groups was 81.8% and 94.0% , and there was no significant difference （X2 = 3. 361, P = 0. 067）. The was no death or other severe complication in both groups. Conclusions The operation time in treatment group was longer than that in control group, and there was no significant difference in clearance and complication rate. Thus it was safe and effctive to perform PCNL in these patients with a history of failed repeated ESWL.

关 键 词：肾结石 肾造口术 经皮 碎石术 体外冲击波碎石 

分 类 号：R699.2[医药卫生—泌尿科学]