经皮肾镜与输尿管软镜在孤立肾结石的应用比较  

Comparison of Percutaneous Nephrolithotomy and Retrograde Intrarenal Surgery for Solitary Renal Calculi

作　　者：林海利[1] 郑周达[1] 杨明根[1] 沈在雄[1] 刘洪杰[1] 林天旗[1] 林建贵[1] 张朝贤[1] 

机构地区：[1]福建医科大学附属漳州市医院泌尿外科,漳州363000

出　　处：《中国微创外科杂志》2016年第4期301-303,307,共4页Chinese Journal of Minimally Invasive Surgery

基　　金：福建省漳州市医院2010年科技计划项目(项目编号:2010026)

摘　　要：目的比较经皮肾镜取石术（percutaneous nephrolithotomy,PCNL）与输尿管软镜碎石术（retrograde intrarenal surgery,RIRS）治疗孤立肾结石的疗效。方法我院2010年4月～2015年6月治疗孤立肾结石64例,其中41例行PCNL,患者取俯卧位,在B超引导下建立皮肾通道,然后碎石取石;23例行RIRS,患者取截石位,沿斑马导丝安置输尿管鞘,插入输尿管软镜碎石取石。结果 PCNL组手术时间（73.0±27.9）min明显短于RIRS组（106.1±29.5）min（t=4.462,P=0.000）;术中出血（141.7±15.0）ml明显多于RIRS组（32.8±6.7）ml（t=32.935,P=0.000）;住院时间（12.8±1.3）d明显长于RIRS组（10.3±1.6）d（t=6.788,P=0.000）;一期清石率78.0%（32/41）明显高于RIRS组52.2%（12/23）（χ^2=4.592,P=0.032）;术后感染率2.4%（1/41）明显低于RIRS组21.7%（5/23）（χ^2=4.388,P=0.036）。61例随访2个月～5年（中位随访时间2.5年）：5例结石复发,中位复发时间2.8年,行ESWL后排出;9例仍有肾功能不全,血肌酐（156.5±17.6）μmol/L,均无须血透治疗,其余病人恢复好。结论 PCNL、RIRS是治疗孤立肾结石的有效手段,两者各有优势：PCNL手术时间短、清石率较高、感染发生率低,RIRS出血少、住院时间短。Objective To compare the curative effect between percutaneous nephrolithotomy（ PCNL） and retrograde intrarenal surgery（ RIRS） for solitary renal calculi. Methods From April 2010 to June 2015,64 patients were diagnosed as having solitary renal calculus. Among them,41 patients were treated with PCNL（ PCNL group）,during which the patients were placed in the prone position,an ultrasound guided percutaneous renal access was established,and then the lithotripsy was performed. Another 23 patients were treated with RIRS（ RIRS group）,during which the patients were placed in the lithotomy position,an ureter sheath was introduced along the zebra guide wire, and flexible ureteroscopy lithotomy was conducted. Results The PCNL group had significantly shorter operation time,more blood loss in operation,longer postoperative hospital stay,higher one-session stone-free rate,and lower postoperative infection rate than those in the RIRS group [（ 73. 0 ± 27. 9） min vs.（ 106. 1 ± 29. 5） min,t = 4. 462,P =0. 000;（ 141. 7 ± 15. 0） ml vs.（ 32. 8 ± 6. 7） ml,t = 32. 935,P = 0. 000;（ 12. 8 ± 1. 3） d vs.（ 10. 3 ± 1. 6） d,t = 6. 788,P =0. 000; 78. 0%（ 32 /41） vs. 52. 2%（ 12 /23）,χ^2= 4. 592,P = 0. 032; 2. 4%（ 1 /41） vs. 21. 7%（ 5 /23）,χ^2= 4. 388,P =0. 036]. A total of 61 cases were followed up for 2 months to 5 years（ median,2. 5 years）. There were 5 cases of stone recurrence,showing a median time to relapse of 2. 8 years,with stones removed after ESWL. Renal insufficiency was found in 9 cases,with blood creatinine level of（ 156. 5 ± 17. 6） μmol / L and no need of blood dialysis treatment. The other patients recovered well.Conclusions Both PCNL and RIRS are effective methods for the treatment of solitary kidney stones. The advantages of PCNL include short operation time,high stone clearance rate,and low infection rate. However the RIRS is characterized with less blood loss and short postoperative hospital stay.

关 键 词：孤立肾 肾结石 经皮肾镜碎石取石术 输尿管软镜碎石术 

分 类 号：R699.2[医药卫生—泌尿科学]