第三代超微经皮肾镜取石术治疗直径2.5 cm及以下高CT值肾结石的疗效及安全性评价  

Therapeutic and safety evaluation of third-generation super-mini percutaneous nephrolithotomy in treating ≤ 2.5 cm kidney calculi with high CT value

作　　者：陈冰[1] 胡振兴[1] 刘聪[1] 虞河江 魏凡杰 余锐 周文杰 CHEN Bing;HU Zhenxing;LIU Cong;YU Hejiang;WEI Fanjie;YU Rui;ZHOU Wenjie(Department of Urology,the People’s Hospital of Leshan Central District,Leshan,Sichuan 614000,P. R. China)

机构地区：[1]乐山市市中区人民医院泌尿外科

出　　处：《华西医学》2019年第7期796-800,共5页West China Medical Journal

基　　金：乐山市重点科技计划项目(19SZD145)

摘　　要：目的对基层医院开展第三代超微通道经皮肾镜取石术(super-mini percutaneous nephrolithotomy,SMP)治疗直径≤2.5cm、CT值≥700Hu肾结石的疗效及安全性进行评估,探讨基层医院开展此项技术的可行性。方法选取2017年7月—2018年7月乐山市市中区人民医院收治的64例结石直径≤2.5cm、CT值≥700Hu的单侧肾结石患者,随机分为两组,其中采取SMP术30例,采取微通道经皮肾镜取石术(mini percutaneous nephrolithotomy,MPCNL)34例,对比分析两组患者术前资料和术中、术后相关技术资料,评价其疗效和安全性。结果两组患者单侧病变均一期顺利完成手术,所有患者术后均留置了双J管,无术后大出血和感染等重大并发症发生。两组在术后血红蛋白下降值、术后即刻清石率、术后1个月清石率、降钙素原>0.1μg/L率等技术指标上差异无统计学意义(P>0.05);SMP组和MPCNL组碎石时间分别为(29.63±6.28)、(25.21±5.19)min,术后住院时间分别为(5.33±0.61)、(9.44±0.96)d,留置肾造瘘管率分别为3.3%、50.0%,镇痛需求率分别为10.0%、58.8%,术后感染性发热率分别为6.7%、26.5%,组间差异均有统计学意义(P<0.05)。结论SMP技术具有创伤小、可无管化、疼痛轻、恢复快、住院时间短等优点,值得广大基层医院推广。Objective To evaluate the efficacy and safety of the third-generation super-mini percutaneous nephrolithotomy (SMP) for the treatment of kidney calculi with diameter of ≤2.5 cm and CT value of ≥700 Hu, and discuss the feasibility of adopting the technology in primary hospitals. Methods The clinical data of 64 patients with unilateral kidney calculi (CT value ≥700 Hu, diameter ≤2.5 cm) treated in the People’s Hospital of Leshan Central District between July 2017 and July 2018 were retrospectively analyzed. After random assignment, 30 patients were treated with SMP and 34 were with mini percutaneous nephrolithotomy (MPCNL). The pre-, intra-, and postoperative data were compared and analyzed to evaluate the efficacy and safety. Results The unilateral lesion operations of both groups were successfully completed in the first phase. All patients were given double J tubes after operation, and there were no major complications such as post-operative hemorrhage and sepsis. There was no statistically significant difference in the post-operative hemoglobin decrease, post-operative immediate stone removal rate, post-operative stone removal rate after one month, or the rate of procalcitonin >0.1 μg/L between the two groups (P>0.05). The differences in the lithotripsy time [(29.63±6.28) vs.(25.21±5.19) minutes], post-operative hospital stay [(5.33±0.61) vs.(9.44±0.96) days], rate of indwelling renal fistula (3.3% vs. 50.0%), analgesic demand rate (10.0% vs. 58.8%), and postoperative infectious fever rate (6.7% vs. 26.5%) between SMP group and MPCNL group were statistically significant (P<0.05). Conclusions SMP has the advantages of less trauma, low systemic inflammatory response syndrome incidence, less pain, quick rehabilitation, short hospital stay, tubeless after surgery, etc. It is worthy of extensive promotion in primary hospitals.

关 键 词：超微通道经皮肾镜取石术 微通道经皮肾镜取石术 肾结石 无管化 

分 类 号：R699.2[医药卫生—泌尿科学]