三种不同方法治疗10～20mm肾下盏结石效果对比分析  

An analysis on the comparison of effects of three different methods in the treatment of 10-20 mm subrenal calyx calculus

作　　者：李纪华[1] 景治安[1] 毛长青[1] 王定占[1] 刘彦军[1] 毕海宁[1] 

机构地区：[1]郑州市第一人民医院泌尿外科,河南郑州450004

出　　处：《中国现代医生》2015年第18期48-50,64,共4页China Modern Doctor

摘　　要：目的评估微创经皮肾镜碎石术、输尿管软镜碎石术与体外冲击波碎石术治疗10~20 mm肾下盏结石的临床疗效。方法回顾性分析2010年6月~2014年9月170例10~20 mm肾下盏结石患者的临床资料,其中64例采用微创经皮肾镜碎石术治疗,60例采用输尿管软镜碎石术治疗,46例采用体外冲击波碎石术治疗,对三种不同手术方式的临床效果进行比较。结果微创经皮肾镜碎石组和输尿管软镜碎石组手术时间分别为（52.5±11.6）min、（82.6±20.8）min,微创经皮肾镜碎石组和输尿管软镜碎石组碎石成功率分别93.8%（60/64）、83.3%（50/60）,而体外冲击波碎石组经过平均2.5次碎石后成功率65.2%（30/46）。微创经皮肾镜组的无石率明显高于另两组,差异有高度统计学意义（P〈0.01）,采用Clavien-Dindo并发症分级系统,并发症的发生率分别为15.6%（10/64）、6.7%（4/60）、2.2%（1/46）,微创经皮肾镜组的并发症发生率明显高于另两组,差异有统计学意义（P〈0.05）。结论对直径为10~20 mm的肾下盏结石,微创经皮肾镜碎石术无石率高,手术时间明显缩短,但其并发症的发生率较高,其治疗方式的选择需结合具体情况慎重考虑。Objective To evaluate the clinical efficacy of minimally invasive percutaneous nephrolithotripsy, flexible ureteroscopy lithotripsy and extracorporeal shock wave lithotripsy in the treatment of 10-20 mm subrenal calyx calculus. Methods Clinical data of 170 patients with 10-20 mm subrenal calyx calculus from June 2010 to September 2014 were retrospectively analyzed. 64 patients were treated by minimally invasive percutaneous nephrolithotripsy, 60 patients were treated by flexible ureteroscopy lithotripsy, and 46 patients were treated by extracorporeal shock wave lithotripsy. Clinical efficacy of the three different surgical procedures was compared. Results Surgery time in minimally invasive percutaneous nephrolithotripsy group and flexible ureteroscopy lithotripsy group was（52.5 ±11.6） minutes and（82.6±20.8） minutes. The successful rate of lithotripsy in minimally invasive percutaneous nephrolithotripsy group and flexible ureteroscopy lithotripsy group was 93.8%（60/64） and 83.3%（50/60）, while the successful rate in extracorporeal shock wave lithotripsy group after an average of 2.5 times of lithotripsy was 65.2%（30/46）. The stone-free rate in minimally invasive percutaneous nephrolithotripsy group was significantly higher than that of the other two groups, and the difference was statistically significant（P〈0.01）. Clavien-Dindo classification of complications was applied, and the incidence rate of complications was 15.6%（10/64）, 6.7%（4/60）, and 2.2%（1/46） respectively. The incidence rate of complications in minimally invasive percutaneous nephrolithotripsy group was significantly higher than that in the other two groups, and the difference was statistically significant（P〈0.05）. Conclusion As for subrenal calyx calculus with a diameter of 10-20 mm, minimally invasive percutaneous nephrolithotripsy has a higher stone-free rate and a shorter surgery time, but a higher incidence rate of complications. The selection of treatment methods needs to be discretely considered acco

关 键 词：输尿管软镜 微创经皮肾镜取石术 体外冲击波碎石术 肾下盏结石 

分 类 号：R699[医药卫生—泌尿科学]