腹腔镜肾盂切开取石术与经皮肾镜碎石取石术在大于2.5cm肾盂结石处理中的临床效果比较  

Comparison of laparoscopic pyelolithotomy and percutaneous nephrolithotomy for renal pelvic stones larger than 2.5 cm

作　　者：蒲小勇[1] 刘久敏[1] 毕学成[1] 李东[1] 黄尚[1] 冯彦华[1] 林楚琪 

机构地区：[1]广东省人民医院//广东省医学科学院泌尿外科,广东广州510080

出　　处：《南方医科大学学报》2017年第2期251-255,共5页Journal of Southern Medical University

基　　金：广东省医学科研基金(A2012016);广东省中医药局科研项目(20161001);广州市科技计划项目(2014J4100041)

摘　　要：目的比较研究腹腔镜肾盂切开取石术(LPL)和经皮肾镜碎石取石术(PCNL)在≥2.5 cm肾盂结石处理中的临床应用和价值。方法回顾性收集我院2011~2016年肾盂结石患者64例。所有患者均为肾盂结石≥2.5 cm。分为2组,其中采用LPL手术32例(LPL组);采用PCNL手术32例(PCNL组)。比较两种手术方式的患者基本参数和结石大小等。同时比较两组手术平均手术时间、估计失血量、输血率、术后住院时间、结石清除率、术后镇痛时间、术中并发症、术后早期和晚期并发症等。比较研究两种手术方式对肾盂结石的治疗效果。结果两组之间在患者基本参数和结石大小方面无统计学意义(P<0.01)。LPL和PCNL手术时间分别为117±23.12、118.16±25.45 min(P>0.01)、估计失血量分别为63±11.25、122±27.78 m L(P<0.01)、输血率分别为0%和6.2%(P<0.01)、术后住院时间分别为4.5±1.34、4.8±2.2 d(P>0.01)、结石清除率分别为93.1%和87.5%(P>0.01)、术后镇痛时间分别为1.7±0.5、1.9±0.6 d(P>0.01)、术中并发症分别为6.2%和25.0%(P<0.01)、术后早期并发症分别为25.0和34.4%(P>0.01)、术后晚期并发症分别为9.4%和12.5%(P>0.01)。结论 PCNL是肾盂结石目前标准的治疗方法,但对腹腔镜熟练的外科医师,LPL对部分肾盂结石的处理是一种可行、安全的治疗方法。Objective To compare the safety, efficacy and complications of laparoscopic pyelolithotomy （LPL） and percutaneous nephrolithotomy （PCNL） for treatment of renal pelvic stones larger than 2.5 cm. Methods From 2011 to 2016, 32 patients underwent LPL and another 32 patients received PCNL for renal pelvic stones larger than 2.5 cm. The baseline characteristics of the patients, stone size, mean operative time, estimated blood loss, postoperative hospital stay, stone-free rate, .postoperative analgesia, blood transfusion, and the intraoperative, early postoperative and long-term complications were compared between the two groups. Results The baseline characteristics and stone size were comparable between the two groups. The mean operative time of LPL and PCNL was 117±23.12 and 118.16±25.45 min, respectively （P〉0.05）. The two groups showed significant differences in the mean estimated blood loss （63±11.25 vs 122±27.78 mL, P〈0.01） and blood transfusion rate （0 vs 6.2%, P〈0.01） but not in postoperative hospital stay （4.5±1.34 vs 4.8±2.2 days, P〉0.05）, stone-free rate （93.1% vs 87.5%, P〉0.05） or the postoperative analgesia time （1.7 ±0.5 and 1.9 ±0.6 days, P〉0.05）. The incidence of intraoperative complications were sign/ficant lower in LPL group than in PCNL group （6.2% vs 25.0%, P〈0.01）, but the incidences of early postoperative complications （25.0% vs 34.4%, P〉0.05） and long-term postoperative complications （9.4% vs 12.5%, P〉0.05） were similar between them. Conclusion PCNL is the standard treatment for pelvic stones larger than 2.5 cm, but for urologists experienced with laparoscopic technique, LPL provides a feasible and safe option for management of such cases.

关 键 词：肾盂结石 腹腔镜肾盂切开取石术 经皮肾镜碎石取石术 比较研究 

分 类 号：R699.2[医药卫生—泌尿科学]