超微通道经皮肾镜与组合式输尿管软镜治疗上尿路结石比较性研究  

Comparative study on the treatment of upper urinary calculi between super-mini percutaneous nephrolithotomy and combined-type flexible ureteroscope

作　　者：冯瑞[1] 李中兴[1] 葛广成[1] 吴丹[1] 王星[1] 贾跃军[1] 

机构地区：[1]镇江市第二人民医院泌尿外科,江苏镇江212002

出　　处：《临床泌尿外科杂志》2018年第2期121-125,共5页Journal of Clinical Urology

基　　金：镇江市科技计划(科技支撑-社会发展)项目(编号SH2013085)

摘　　要：目的:比较超微通道经皮肾镜及组合式输尿管软镜治疗上尿路结石的疗效及并发症。方法:将69例患者随机分为两组,其中32例患者行超微通道经皮肾镜取石术(超微经皮肾镜组),37例患者行组合式输尿管软镜碎石术(组合式输尿管软镜组),比较两组患者的术中手术时间、并发症、术后血红蛋白下降量、术后降钙素原水平、术后住院时间、结石清除率。结果:超微经皮肾镜组手术时间为(55.5±14.8)min,发生胸膜损伤3例(9.38%),肾周血肿1例(3.22%),无其他并发症,术后1、6、24、48h血红蛋白下降量分别为(11.3±6.0)g/L、(11.5±5.3)g/L、(13.8±5.9)g/L、(14.0±6.1)g/L,术后1、24、48h降钙素原检测分别为(1.01±0.25)ng/ml、(1.47±0.36)ng/ml、(0.91±0.23)ng/ml,术后住院时间为(5.0±1.5)d,术后第1天及术后1个月结石清除率为87.50%、96.88%;组合式输尿管软镜组手术时间为(72.5±31.2)min,肾周血肿2例(5.41%),无其他并发症,术后1、6、24、48h血红蛋白下降量分别为(3.5±2.2)g/L、(4.0±2.0)g/L、(4.4±1.9)g/L、(4.4±2.1)g/L,术后1、24、48h降钙素原检测分别为(0.60±0.11)ng/ml、(0.76±0.09)ng/ml、(0.50±0.12)ng/ml,术后住院时间为(4.3±1.1)d,术后第1天及术后1个月结石清除率为27.03%、70.27%。结论:2种术式手术时间、术中并发症、术后住院时间比较差异无统计学意义,超微通道经皮肾镜取石术出血及术后感染发生率高于组合式输尿管软镜碎石术,但是结石清除率方面超微经皮肾镜组优于组合式输尿管软镜组。Objective：To compare the efficacy and complications between super-mini percutaneous nephrolithotomy and combined-type flexible ureteroscope in the treatment of upper urinary tract calculi.Method：Sixty-nine patients were randomly divided into two groups,32 patients in super-mini percutaneous nephrolithotomy group and 37 cases in combined ureteroscope lithotripsy group.We compared operative time,postoperative complications,postoperative hemoglobin decrease,procalcitonin levels,postoperative hospital stay and the stone-free rate between two groups of patients.Result：The operation time was（55.5±14.8）min in 32 patients with super-mini percutaneous nephrolithotomy.No other complications were found in this group except for one perineal hematoma（3.22%）and three pleural injuries（9.38%）.One hour,6 hours,24 hours and 48 hours postoperatively patients＇ hemoglobin decreased（11.3±6.0）g/L,（11.5±5.3）g/L,（13.8±5.9）g/L,（14.0±6.1）g/L,respectively.Procalcitonin at 1 hour,24 hours and 48 hours after operation were（1.01±0.25）ng/ml,（1.47±0.36）ng/ml,（0.91±0.23）ng/ml.Postoperative hospital stay was（5.0±1.5）d,and the stone-free rate was 87.50% and 96.88% on the first and thirtieth day postoperatively.The operation time of 37 cases of combined-type flexible ureteroscope group was（72.5±31.2）min.One hour,6 hours,24 hours and 48 hours postoperatively patients＇ hemoglobin decreased（3.5±2.2）g/L,（4.0±2.0）g/L,（4.4±1.9）g/L,（4.4±2.1）g/L,respectively（P0.05）.Also,no other complications were found in this group except for two perineal hematoma（5.41%）.Procalcitonin at 1 hour,24 hours and 48 hours after operation were（0.60±0.11）ng/ml,（0.76±0.09）ng/ml,（0.50±0.12）ng/ml,respectively.The postoperative hospital stay was（4.3±1.1）d.The stone-free rate was 27.03% and 70.27% on the first and thirtieth day postoperatively.Conclusion：There was no significant difference in the time of operation,intraoperative complications and postoperative hospital

关 键 词：超微通道 经皮肾镜 输尿管软镜 组合式 上尿路结石 

分 类 号：R692.4[医药卫生—泌尿科学]