输尿管软镜联合经皮肾镜碎石术治疗复杂性肾结石的临床分析  

Clinical effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on complex nephrolithiasis

作　　者：张艳平[1] 王亚轩[1] 常学良[1] 刘凯隆[1] 路保赛[1] 韩振伟[1] 尹跃伟 滕志海[1] 李景东[1] 黎玮[1] ZHANG Yanping;WANG Yaxuan;CHANG Xueliang;LIU Kailong;LU Baosai;HAN Zhenwei;YI Yuewei;TENG Zhihai;LI Jingdong;LI Wei(Department of Urinary Surgery,The Second Hospital of Hebei Medical University,Hebei,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院泌尿外科,石家庄市050000

出　　处：《河北医药》2018年第8期1156-1159,共4页Hebei Medical Journal

摘　　要：目的探讨输尿管软镜联合经皮肾镜碎石术治疗复杂性肾结石的临床疗效。方法选取2015年1月至2017年7月复杂性肾结石51例,非随机分为对照组和观察组,其中对照组20例,结石大小2.8~5.4 cm,平均(3.73±0.73)cm,行经皮肾镜碎石术。观察组共31例,分为观察1组,共16例,结石大小2.8~5.2 cm,平均(3.74±3.93)cm,为一期同时行经皮肾镜碎石联合输尿管软镜碎石;观察2组,共15例,结石大小2.9~5.2 cm,平均(3.93±0.73)cm,为经皮肾镜碎石术后二期逆行输尿管软镜结合原通道经皮肾镜碎石。比较3个组手术时间、手术结石清除率、术后并发症发生率等情况。结果 51例手术均顺利完成。对照组手术时间(89.50±18.27)min与观察1组(81.56±14.57)min的无明显差异(P>0.05),但较观察2组的总体手术时间(121.00±18.15)min明显缩短(P<0.05)。观察组中观察1组(93.7%)及观察2组(93.3%)的结石清除率比对照组(65.0%)明显提高(P<0.05),但观察1组和观察2组比较差异无统计学意义(P>0.05)。术后并发症为ClavienⅠ或Ⅱ级,3个组的并发症差异无统计学意义(P>0.05)。结论逆行输尿管软镜联合经皮肾镜治疗复杂性肾结石,可以相互配合,缩短手术时间,提高手术效率,降低手术并发症,是临床中治疗复杂性肾结石安全、可行的手术途径。Objective To explore the clinical effects of flexible ureteroscopy combined with percutaneous nephrolithotomy(PCNL)on complex nephrolithiasis.Methods Fifty-one patients with complex nephrolithiasis who were treated in our hospital from January 2015 to July 2017 were randomly divided into control group(n=20)and observation group(n=31),which was subdivided into the first observation group(n=16)and the second observation group(n=15).The patients in control group who had kidney stones with a mean diameter of[3.73±0.73(range,2.8~5.4)]cm were treated by PCNL.By contrast,the patients in the first observation group who had stones with a mean diameter of[3.74±3.93(range,2.8~5.2)]cm were treated by PCNL combined with flexible ureteroscopy at stage one,and the patients in the second observation group who had stones with a mean diameter of 3.93±0.73(range,2.9~5.2)cm were treated by PCNL before being treated by flexible ureteroscopy.Then,the operation time,stone clearance rate and complication rate were observed and compared among groups.Results All the surgeries were successfully completed in 51 patients.The operation time in control group was(89.50±18.27)min,which in the first observation group was(81.56±14.57)min,both were significantly shorter than that[(121.00±18.15)min]in the second observation group(P<0.05).However there was no significant difference in operation time between control group and the first observation group(P>0.05).The stone clearance rates in the first observation group(93.7%)and the second observation group(93.3%)were significantly higher than that(65%)in control group(P<0.05),but there was no significant difference between the two observation groups(P>0.05).The clavien-Dindo grade I and Clavien-Dindo grade II of poestoperative complicatins were observed among the three groups,but there were no significant differences among the three groups.Conclusion The retrograde flexible ureteroscopy combined with percutaneous nephrolithotomy in treatment of complex nephrolithiasis can shorten operation time a

关 键 词：经皮肾镜 输尿管软镜 钬激光 复杂性肾结石 

分 类 号：R692.4[医药卫生—泌尿科学]