输尿管软镜钬激光碎石术与单通道经皮肾镜取石术联合及单独使用治疗复杂性肾结石的疗效评价及其安全性分析  

The rapeutic effects of Holmium laser lithotripsy with flexible ureteroscopy and single-tract minimally invasive percutaneous nephrolithotomy in the treatment of complex kidney stones

作　　者：刘勇[1] 王涛[1] 果佳[1] 

机构地区：[1]解放军第59医院泌尿外科,云南开远661600

出　　处：《中国医学装备》2016年第11期80-84,共5页China Medical Equipment

摘　　要：目的:探讨输尿管软镜钬激光碎石术联合单通道经皮肾镜对复杂性肾结石的疗效及其安全性的分析。方法:选取120例复杂性肾结石患者,按照随机数表法将其分为A组、B和C组,每组40例。A组使用输尿管软镜钬激光碎石,B组采用单通道经皮肾镜取石,C组采用两种手术联合治疗。三组患者术后第2 d采用B超复查,比较其结石清除率及视觉疼痛评分(VAS)情况,记录分析术前、术后三组患者的血清超敏C反应蛋白水平(hs-CRP)、血清肌酐(SCr)上升值及血红蛋白(Hb)下降值,以及各组手术相关情况和术后1个月并发症发生率。结果:A组手术时间、术中出血量、住院时间、SCr上升值以及Hb下降值等均少于C组(q=3.70,q=35.72,q=8.73;q=10.6,q=16.55;P<0.05)和B组(q=12.96,q=66.84,q=15.65,q=18.26,q=26.15;P<0.05),同时C组也均少于B组,且差异均有统计学意义(q=9.26,q=31.12,q=6.91,q=7.66,q=9.61;P<0.05);术后VAS及hs-CRPA组显著低于C组和B组,但A组术后感染及发热例数明显多于B组,两组相比有差异(x^2=6.13,x^2=8.89;P<0.05)、A组上述指标也显著多于C组,且差异均有统计学意义(x^2=4.11,x^2=6.13,P<0.05);术后复查结石完全清除率C组清除率100%远高于A组的80%,两组相比有差异(x^2=8.89,P<0.05),同时也显著高于B组,两组相比有差异(x^2=10.14,P<0.05)。结论:在患者可耐受的情况下,同期输尿管软镜钬激光联合经皮肾镜治疗复杂性肾结石比单一使用其中的一种手术效果更好,且预后较好,并不增加手术风险,值得推广应用。Objective： To observe the therapeutic effects of Holmium laser lithotripsy with flexible ureteroscopy and single-tract minimally invasive percutaneous nephrolithotomy in the treatment of complex kidney stones. Methods： The 120 patients with complex kidney stones were chosen, and randomly devided into 3 groups（each group n=40）. The A group received the Holmium laser lithotripsy with flexible ureteroscopy, the B group got the treatment with minimally invasive percutaneous nephrolithotomy, and the C group got the treatment with the two methods combined. The consumption of the operation time, amount of bleeding during operation, the length of hospital stay, the rate of stone clearance, the scores of VAS, the level of Hs-CRP before and after the operation, the range of the rise of the SCr, the reduction of the Hb, the rate of morbidity after the operation were compared between the 3 groups. Results： The A owned the least consumption of the operation time, amount of bleeding during operation, the length of hospital stay, the rise of the SCr, the reduction of the Hb and the level of the hs-CRP after the operation than the other 2 groups, and the index above of C were less than the B. The differences were statistically significant（P〈0.05）. The A owned the lowest scores of the VAS in the 3 groups, but the C had the highest rate of stone clearance（100%）, far more than the other 2 groups（80%, x^2=8.89; 77.5%, x^2=10.14; P〈0.05）. The difference was statistically significant（P〈0.05）. And the A had the higher rate of the postoperative infection and fervescence than the B（x^2=6.13, x^2=8.89, P〈0.05） and C（x^2=4.11, x^2=6.13, P〈0.05）. Conclusion： The therapeutic effects of Holmium laser lithotripsy with flexible ureteroscopy and single-tract minimally invasive percutaneous nephrolithotomy in the treatment of complex kidney stones was good and safe, and it is worth popularizing in clinical.

关 键 词：输尿管软镜 钬激光 经皮肾镜 复杂性肾结石 

分 类 号：R699[医药卫生—泌尿科学]