目的 比较经皮肾碎石取石术微通道组（percutaneous nephrolithotomy by micro channel, MPCNL）和标准通道组(percutaneous nephrolithotomy by the standard channel，PCNL)治疗复杂性上尿路结石疗效和安全性。方法 回顾性分析2005-05至2011-12期间1753例复杂性上尿路结石患者临床资料，其中微通道组1146例和标准通道组607例。对两组患者的手术时间、住院天数、半鹿角和全鹿角型一期结石净石率、手术严重并发症等项指标进行比较。结果 两组均成功建立F16和F22经皮肾通道并行碎石取石术。半鹿角和全鹿角形结石患者一期结石净石率微通道组（82.14%）明显低于标准通道组（94.29%），差异有统计学意义。其余部位一期结石净石率无统计学差异。微通道组平均手术时间（72.5±18.5）min明显长于标准通道组（34.1±15.0）min，而平均住院时间前者（9.2±1.9）d少于后者（14.4±3.2）d，前者严重并发症发生率（0.96%）小于后者（2.14%），以上差别均有统计学意义（P＜0.05）。结论 两种经皮肾通道各有其优点，标准通道碎石效率高，适合一期处理较大的鹿角形结石、肾多发结石、肾感染性结石；微通道适于输尿管上段结石、肾盏单发结石、小于2.5 cm的肾内结石，具有损伤风险低的优势。
Abstract
Objective To compare the efficacy and safety of percutaneous nephrolithotomy by micro channel (MPCNL) and the standard channel (PCNL) in the treatment of complicated upper tract urinary calculi. Methods 1753 patients with complex upper urinary tract calculi from May 2005 to December 2011 were randomly allocated into MPCNL group (1146 cases) and PCNL group (607 cases), separately. The average operation time and hospital stay, first phase semi-staghorn calculi and full staghorn calculi stone clearance rates, serious complications and other indexes were compared. Results In the two groups of 1753 patients, the F16 and F22 channels were successfully established using MPCNL or PCNL. The semi staghorn calculi and full staghorn calculi stone claerance rates in MPCNL group were significantly lower than those in PCNL group (82.14%) vs (94.29%)(P＜0.05). The stone clearance rate of the remaining parts showed no differences. MPCNL was associated with longer operation time (72.5±18.5) mins vs (34.1±15.0) mins (P<0.05), shorter average hospital stay (9.2±1.9) days vs (14.4±3.2) days (P<0.05), and lower rate of severe complications(0.96%) vs (2.14%) (P<0.05). Conclusions Both MPCNL and PCNL have their own advantages. The standard channel PCNL combined with EMS stone clearance system is highly efficient, suitable for larger pelvic stones, multiple kidney stones, and infective kidney stones. The MPCNL is suitable for upper ureteral calculi, calyceal single stones, less than 2.5 cm renal stones. The MPCNL has lower risk of damage.
关键词
经皮肾碎石取石术 /
微通道 /
标准通道 /
复杂性上尿路结石
Key words
percutaneous nephrolithotomy /
minimally puncture channel /
standard puncture channel /
complicated upper urinary calculi
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
［1］ 吴阶平. 吴阶平泌尿外科学［M］.济南: 山东科学技术出版社,2004: 811.
［2］ 王树声，向松涛，陈志强，等.复杂性上尿路结石的微创综合治疗［J］.中华泌尿外科杂志，2005，26（8）：539-541.
［3］ 叶章群,邓耀良,董 诚,等.泌尿系结石［M］. 2版.北京: 人民卫生出版社,2010: 630-631.
［4］ Osman M, Wendt-Nordahl G, Heger K,et al. Percutaneous nephrolithotomy with ultrasonography guided renal access: experience from over 300 cases ［J］. BJU Int, 2005, 96(6): 875-878.
［5］ 王晓峰，杨 波.上尿路结石治疗的现状和未来［J］.北京大学学报（医学版），2010，42（4）：369-373.
［6］ 李 逊.经皮肾镜取石术的微创理念［J］.中华腔镜泌尿外科杂志，2010，4（3）：176-179.
［7］ 徐桂彬，李 逊，何永忠,等. 微创肾镜与输尿管镜在微创经皮肾穿刺取石术治疗上尿路结石中的对比研究［J］.临床泌尿外科杂志，2011，26（3）:172-176.
［8］ 薛 杰，程 帆，余伟民，等. 微创经皮肾镜取石术与标准通道经皮肾镜取石术的疗效比较［J］. 武汉大学学报（医学版），2009，30（6）：823-826.
［9］ 刘永达，袁 坚，李 逊，等. 微创经皮肾镜取石术的并发症及其防治［J］.中华外科杂志，2008，46（3）：200-202.
［10］ Desai M, Jain P, Ganpule A, et al. Developments in technique and technology: the effect on the results of percutaneous nephrolithotomy for staghorn calculi ［J］. BJU Int, 2009, 104(4): 542-548.
［11］ Kukreja R, Desai M, Patel S, et al. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study ［J］. J Endourol, 2004, 18（8）: 715-722.
［12］ 杨后猛，曾国华，邵法明, 等. 不同大小肾通道对猪肾动脉损伤的实验研究［J］. 中华泌尿外科杂志，2011，23（5）：316-317.
［13］ 杨 波，李建兴，胡卫国，等. 两步法建立标准通道经皮肾镜取石3052例临床报告［J］. 北京大学学报（医学版），2010，42（4）：447-450.
［14］ 何永忠，刘建河，曾国华，等.微创经皮肾镜取石术后迟发出血原因及介入治疗［J］.中华泌尿外科杂志，2006,27（6）：371-373.
［15］ Finkelstein J, Eckersberger E, Sadri H, et al. Open versus laparoscopic versus robot-assisted laparoscopic prostatectomy: the European and US experience ［J］. Rev Urol, 2010, 12(1): 35-43.
［16］ Belharet K, Folio D, Ferreira A. MRI-based microrobotic system for the propulsion and navigation of ferromagnetic microcapsules ［J］. Minim Invasive Ther Allied Technol, 2010, 19(3): 157-169.
(2012-10-20
PDF(769 KB)
