两种径路经皮肾镜治疗肾上盏结石的比较研究  

Comparative study of percutaneous nephrolithotomy for renal upper calyceal stones with two approa-ches

作　　者：张博威[1] 王东文[2] 庞磊[3] 

机构地区：[1]太原市中心医院泌尿外科,030009 [2]山西医科大学第一医院泌尿外科 [3]山西省人民医院泌尿外科

出　　处：《中华泌尿外科杂志》2013年第5期337-339,共3页Chinese Journal of Urology

摘　　要：目的比较经第11肋上缘径路和下缘径路微创经皮肾镜治疗肾上盏结石的效果。方法2008年7月至2010年7月收治肾结石患者216例，其中肾上盏结石66例。经第11肋上缘径路（A组）32例；男15例，女17例，平均年龄42岁；结石位于左侧10例，右侧2l例，双侧1例，结石长径平均1．9cm。经第11肋下缘径路（B组）34例；男14例，女20例，平均年龄44岁；结石位于左侧13例，右侧21例，结石长径平均1．7cm。两组均行微创经皮肾镜钬激光碎石取石术。比较两组穿刺时间、一次性穿刺成功率、一次性结石清除率。结果穿刺时间A组为3．0～14．0min，平均5．8min；B组为3．0～17．0min，平均6．4min。两组一次性穿刺成功率均为100％。一次性结石清除率A组为100％（32／32），B组为88％（30／34），两组比较差异有统计学意义（P〈0．05）。两组均未发生气胸、血胸、腹腔脏器损伤等手术并发症。结论经第11肋上缘径路微创经皮肾镜治疗肾上盏结石与常规的第11肋下缘径路相比，经皮肾通道距离短，疗效确切，结石清除率较高。Objective To investigate and compare the effects of minimally invasive percutaneous nephrolithotomy for renal upper calyceal stones with approaches through upper edge of the llth rib and lower edge of the llth rib. Methods Two hundred and sixteen cases of kidney stones in our hospital from July 2008 to July 2010 were reviewed. Of which 66 patients were renal calyceal stones. Thirty-two patients under- went the approach through upper edge of the llth rib （group A） , with 15 males and 17 females, with a mean age of 42 years. Ten cases with stone were located on the left side, right 21 cases, and bilateral 1 case, with calculi average maximum diameter of 1.9 cm. Thirty-four cases underwent the approach through lower edge of the llth path （B group） , with 14 males and 20 females, with a mean age of 44 years. Thir- teen cases with stone were located on the left side, right 21 cases, with calculi average maximum diameter of 1.7 cm. The two groups underwent minimally invasive percutaneous nephrolithotomy holmium laser lithotrip- sy lithotomy. The average puncture time, one-time success rate of puncture and disposable stone-free rate were compared. Results Puncture time of group A was 3.0 - 14.0 rain, with an average of 5.8 min, and group B was 3.0 - 17.0 rain with an average of 6.4 min. The disposable puncture success rate of the two groups was 100%. Disposable stone-free rate was 100% in group A （32/32） , and 88% in group B （30/ 34） （ P 〈 0.05 ）. There were no poeumothorax, hemothorax, abdominal viscera injury in two groups. Conclusions The minimally invasive percutaneous nephrolithotomy through the approach of upper edge of the llth rib was better than through the approach of conventional lower edge of 11 subcostal margin, with shorter percutaneous renal access distance, and higher stone-free rate.

关 键 词：肾造口术 经皮 肾上盏结石 11肋 

分 类 号：R699.2[医药卫生—泌尿科学]