逆行肾内手术与经皮肾镜碎石术治疗直径小于1.5cm肾盂结石的疗效比较  

Comparison of retrograde intra-renal surgery and percutaneous nephrolithotomy in treating renal pelvic stone less than 1.5 centimeters

作　　者：肖强[1] 黄艳春[1] 

机构地区：[1]湖北科技学院附属二医院外科

出　　处：《临床外科杂志》2015年第2期113-115,共3页Journal of Clinical Surgery

摘　　要：目的：探讨直径≤1．5 cm 的肾盂结石最佳微创治疗方法。方法直径≤1．5 cm 肾盂结石90例，其中47例行逆行途径的肾内手术（RIRS），采用输尿管硬镜联合软镜钬激光碎石，43例采用经皮肾镜碎石术（PCNL）。比较分析两种方法治疗结石的手术时间、碎石成功率、术后住院时间和并发症。结果RIRS 组和 PCNL 组结石平均直径分别为1．2 cm（1．0～1．5 cm）及1．3 cm （1．0～1．5 cm）。RIRS 组手术均顺利完成，其中32例手术过程中换用输尿管软镜击碎冲入肾盏的结石。平均手术时间44 min（25～70 min），一期结石清除率达95．74％（45／47），术后发热 2例，血红蛋白和红细胞压积轻度下降，血红蛋白平均下降（0．18±0．06）g／L，红细胞压积平均下降0．11％。所有患者均未发生并发症。PCNL 组手术均顺利完成，平均手术时间70 min（45～90 min），一期结石清除率达95．35％（41／43），术后发热 2例，血红蛋白平均下降（17．25±6．70）g／L，红细胞压积平均下降5．62％。PCNL2例出现明显术中、术后出血。结论对于直径≤1．5 cm 的肾盂结石，RIRS组具有良好的清石率，其经自然腔道内镜手术的特点使其创伤小，主要并发症发生率明显低于 PC-NL，手术时间及住院时间均具有明显优势。对于直径≤1．5 cm 的肾盂结石，应首选 RIRS 手术。Objective To explore the best minimal invasive method in treating renal pelvic stones less than 1.5 cm.Methods A total of 90 patients with renal pelvic stone less than 1.5 cm were enrolled, including 47 cases of retrograde intrarenal surgery（RIRS）by rigid and flexible ureteroscopy with holmium laser lithotripsy,and 43 cases of percutaneous nephrolithotomy（PCNL）by holmium laser lithotripsy.Opera-tion time,stonefree rate（SFR）,hospitalization,and complications were analyzed for comparison.Results The average sizes of stone in the RIRS group and PCNL group were 1.2 cm（range 1.0 ~1.5 cm）and 1.3 cm （1.0 ~1.5 cm）,respectively.In the RIRS group,45（95.74%）patients out of 47 had complete clearance and 32 patients needed combination of flexible ureteroscopy to fragmentate the stones falling into the renal calices.The operation time was 44 min（range 27 ~70 min）with postoperative fever in 2 cases.The decrea-sing in hemoglobin and hematocrit was（0.18 ±0.06）g/L and 0.11%,respectively.No major complication was recorded.In PCNL group,the mean operation time was 70min（range 45 ~90 min）with a stone-free rate of 95.35%（41 /43）.The decreasing in hemoglobin and hematocrit was（17.25 ±6.70）g/L and 5. 62%,respectively.The complications in PCNL group were postoperative fever in two cases and bleeding in two cases.Conclusion RIRS has the advantages of natural orifice endoscopic surgery in shortening opera-tion time,reducing blood transfusion requirements,and decreasing postoperative complications.For renal pelvic stone less than 1.5 cm,RIRS can be the primary choice.

关 键 词：肾盂结石 逆行途径肾内手术 经皮肾镜 钬激光碎石 

分 类 号：R699.2[医药卫生—泌尿科学]