肾窦内肾盂及肾后唇实质弧形切开取石术与经皮肾镜取石术治疗复杂性鹿角形肾结石的疗效比较  

Comparison of treating complex straghorn renal calculus between arc renal parenchyma incision of pelvis within renal sinus and renal posterior lib for the removal with percutaneous nephrolithotomy

作　　者：李化升 梁烽扬 罗书锋 李燕凤[1] 罗超[1] 郑业辉[1] 莫鹏[1] 陈戈[1] 吴志健[1] 潘家紧 

机构地区：[1]广西壮族自治区玉林市红十字会医院泌尿外科,广西玉林537000

出　　处：《中国内镜杂志》2013年第10期1031-1035,共5页China Journal of Endoscopy

摘　　要：目的肾窦内肾盂及肾后唇实质弧形切开取石术与经皮肾镜取石术治疗复杂性鹿角形肾结石的效果比较。方法将87例复杂性鹿角形肾结石患者随机分成两组,采用肾窦内肾盂及肾后唇实质弧形切开取石术(开放组)与经皮肾镜取石术(PCNL组)分别治疗46例和41例,观察血BUN、Scr、胱抑素C(cystatin C,Cys C)、β2-MG和尿β2-MG手术前后变化,对手术时间、出血量、输血率、结石取净率和并发症作比较。结果两组手术均获成功。两组术前、术后血BUN、Scr、CysC、β2-MG、尿β2-MG相比差异无显著性(P>0.05),并发症相比亦差异无显著性(P>0.05),手术时间、出血量、输血率和结石取净率相比差异有显著性(P<0.05)。PCNL组一期术后结石取净率为82.9%,开放组结石取净率达97.8%。结论 PCNL对患者损伤轻,一期单通道结石取净率低,常需一期多通道或二期多通道或多期多通道取石,开放组结石取净率高,对腰部切口各层损伤大,外观手术疤痕长,恢复较慢,但仍是部分患者选择的较理想术式。[ Objective ] To compare the efficacy of treating complex straghorn renal calculus between arc renal parenehyma incision of pelvis within renal sinus and renal posterior lib for the removal with pereutaneous nephrolithotomy. [Method] 87cases of patients were randomly divided into two groups, among them 46 cases （ surgical operation group） underwent arc renal parenchyma incision of pelvis within renal sinus and renal posterior lib for the removal. 41 ones （ PCNL group） performed pereutaneous nephrolithotomy. The changes of blood BUN, Scr, CysC, β2-MG and urinary β2-MG were observed; In the meantime compared with their intraoperative time, blood loss, the rates of blood transfusion, the stone free-rates of these two groups before and after the operation. [ Results ] Both groups succeeded. There was statistically difference in the changes of blood BUN, Ser, CysC, β2-MG and urinary β2-MG （P 〉0.05）. No complications occurred （P 〉0.05）, but there were some distinct meanings in the operative time, blood loss, the rate of blood transfusion and stone free-rate （P 〈0.05）. For PCNL group the stone free-rate was 82.9% in one-session, while for surgical operation group it was 97.8%. [Conclusion] The advantage of PCNL was slight wound to the patient, but it was low stone free-rate in a single-track one-session, it usually needed muhiple- tracks in one-session or multiple-tracks double-sessions or multiple-tracks multiple-sessions fbr the calculi. For surgical operation group it was high stone free-rate, but badly injured to the waist incision, long scar and slow reeovery. However, it was still the best way to some patients.

关 键 词：肾结石 外科手术 经皮肾镜取石术 

分 类 号：R692.4[医药卫生—泌尿科学]