经尿道输尿管软镜与经皮肾镜治疗单侧肾结石的比较  

Comparison of the therapeutic effect of kidney calculi: ureteroscopy lithtripsy versus percutaneous nephrolithotomy

作　　者：阮东丽[1] 张更[1] 李智斌[1] 马帅军[1] 刘克普[1] 杨力军[1] 袁建林[1] 

机构地区：[1]第四军医大学西京医院泌尿外科,西安710032

出　　处：《中华腔镜泌尿外科杂志（电子版）》2015年第3期22-25,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的研究不同方法治疗肾结石的临床疗效及安全性。方法回顾性分析2011年3月至2013年2月第四军医大学西京医院泌尿外科收治的142例肾结石患者的临床资料,将其分为经尿道输尿管软镜碎石术组58例,经皮肾镜碎石术组84例。比较两种方法治疗肾结石的手术时间、出血量、清石率、住院天数与手术并发症。结果输尿管镜组结石大小为(2.4±1.6)cm,经皮肾镜组结石大小为(3.1±2.8)cm(P>0.05)。输尿管镜组中3例因结石难以处理、手术时间过长等原因改行经皮肾镜手术治疗,术后出现发热4例,均未出现严重并发症。经皮肾镜组术中5例因结石冲入肾盏致肾镜无法到达,用输尿管镜从原操作鞘进入辅助取石,术中因出血较多输血2例,术后发热6例,术后出血3例,给予止血、输血、对症治疗后均明显好转。输尿管镜组与经皮肾镜组一期清石率分别为87.9%(51/58)及94%(79/84),并发症发生率分别为6.7%(4/54)及10.7%(9/84),两组间比较差异无统计学意义。手术时间分别为(94±36)min及(63±20)min,血红蛋白下降数值分别为(2.3±1.9)g/L及(7.7±5.8)g/L,住院天数分别为(4.8±1.9)d及(7.4±3.2)d,组间比较差异有统计学意义。结论与经皮肾镜取石术治疗肾结石比较,经尿道输尿管镜下碎石术具有创伤小、住院天数短、并发症少等优势。Objective To investigate the therapeutic effect and security between ureteroscopy lithtripsy and percutaneous nephrolithotomy to treatment kidney calculus. Methods From March 2011 to February 2013, a total of 142 cases were treated by transurethral ureteroscopy （58 cases） or percutaneous nephrolithotomy （84 cases）. Operative time, decreased hemoglobin values, stone free rate, postoperative hospital stay and complications between two groups were compared. Results The mean stone burden of the ureteroscopy lithtripsy and percutaneous nephrolithotomy were （2.4± 1.6） cm and （3.1±2.8） cm. Because of the difficulty of handling the stones and the long operative time, three cases of ureteroscopy lithtripsy group were converted to percutaneous nephrolithotomy surgery. No serious complication was recorded except postoperative fever in 4 cases. In percutaneous nephrolithotomy group, because of stones into the calyces, mirror could not reach, fives cases in percutaneous nephrolithotomy group underwent ureteroscopy to find stone from the original operation sheath. Two cases needed blood transfusin. Intraoperative, postoperative fever occurred in 6 cases, three cases had obvious postoperative haemorrhage, cured by blood transfusion. The stone free rate of the ureteroscopy lithtripsy and percutaneous nephrolithotomy groups was 87.9% （51/58） and 94% （79/84） respectively, had no statistical significance. Operative time was （94±36） min and （63±20） min, hemoglobin decline was （2.3±1.9）g/L and （7.7±5.8） g/L, the postoperative hospital stay was （4.8±1.9） d and （7.4±3.2） d in the two groups, all of them had significant difference between twogroups. Conclusions Compared with percutaneous nephrolithotomy treatment of kidney stones, ureteroscopy lithtripsy have the advantages of less trauma, shorter hospital stay and fewer complications.

关 键 词：肾结石 输尿管软镜 肾造口术 经皮 

分 类 号：R699.2[医药卫生—泌尿科学]