目的 比较微创经皮肾镜(minipercutaneous,Mini-PCNL)与逆行输尿管软镜(retrograde intrarenal surgery,RIRS)治疗直径1~2 cm的肾结石的临床疗效。方法 收集2015-03至2017-04医院泌尿外科收治的72例患者的临床资料,按手术方法分为 Mini-PCNL组和RIRS组,每组36例,对两组的手术结石清除率、重复治疗率、并发症、手术时间、术后镇痛、血红蛋白下降、治疗费用和住院天数进行对比。结果 Mini-PCNL组结石清除率(94.44%)明显高于RIRS组(75.00%),差异有统计学意义(P<0.05)。Mini-PCNL组重复治疗率、手术时间、治疗费用与RIRS组比较,差异均有统计学意义(P<0.05)。但术后24 h镇痛药用量和血红蛋白下降高于RIRS组,差异均有统计学意义(P<0.05)。Mini-PCNL组住院天数和并发症高于RIRS组,但差异无统计学意义。结论 Mini-PCNL治疗1~2 cm的肾结石的临床疗效好、手术时间短、费用少,值得临床推广。
Abstract
Objective To compare the clinical effect of mini-percutaneous nephrolithotomy (Mini-PCNL) and retrograde intrarenal surgery (RIRS)in the treatment of renal calculi with a diameter of 1to 2 cm. Methods The clinical data on 72 patients admitted to the Department of Urology at our hospital between March 2015 and April 2017 was collected and equally divided into the Mini-PCNL group and RIRS group according to the surgical approach. The stone clearance rate, repeated treatment rate, complications, duration of surgery, postoperative analgesia, hemoglobin decrease,costs and hospital stay were compared between the two groups. Results The stone clearance rate of the Mini-PCNL group(94.44%) was significantly higher than that of the RIRS group (75.00%)(P<0.05). The Mini- PCNL group compared favorably with the RIRS group in terms of the repeated treatment rate ,duration of surgery, postoperative analgesia, hemoglobin decrease and treatment cost (P<0.05).The dosage of analgesics and levels of hemoglobin 24h postoperatively decreased more significantly in the Mini- PCNL group than in the RIRS group, and the difference was statistically significant (P<0.05).The hospital stay and rate of complications in the Mini-PCNL group were longer or higher than those of the RIRS group, but the difference was not statistically significant. Conclusions Mini-PCNL has a good clinical effect and requires short duration of surgery and low treatment costs when used to treat renal calculi with a diameter of 1 to 2 cm, which should be made more accessible.
关键词
微通道 /
经皮肾镜 /
肾结石 /
输尿管软镜
Key words
mini /
percutaneous nephrolithotomy /
renal calculi /
retrograde intrarenal surgery
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 那彦群,叶章群,孙颖浩,等.2014版中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:137.
[2] Bandi G, Best S L, Nakada S Y. Current practice patterns in the management of upper urinary tract calculi in the north central United States[J] . J Endourol, 2008,22(10): 631-636.
[3] Jackman S V, Docimo S G, Cadeddu J A, et al. The‘Mini-perc'technique: a less invasive alternative to percutaneous nephrolithotomy[J]. World J Urol, 1998,16:371-374.
[4] Lahme S, Zimmermanns V, Hochmuth A, et al. Minimally invasive PCNL (Mini-perc). alternative treatment modality or replacement of conventional PCNL[J]. Urologe A, 2008,47:563-568.
[5] Mishra S, Sharma R, Garg C, et al. Prospective comparative study of Miniperc and standard PNL for treatment of 1 to 2 cm size renal stone[J]. BJU Int, 2011,108: 896-899.
[6] 孙颖浩,戚晓升,王林辉,等.输尿管软镜下钬激光碎石术治疗肾结石(附 5 1 例报告)[J].中华泌尿外科杂志,2002,23(11):681-682.
[7] 胡俊杰,廖国强,卞崔冬,等.输尿管镜下双频激光碎石术治疗输尿管结石2 6 8 例报告[J]. 中国微创外科杂志,2007,7(10):946-947 .
[8] Chung B I, Aron M, Hegarty N J, et al. Ureteroscopic versus percutaneous treatment for medium-size (1- 2cm) renal calculi[J]. J Endourol, 2008,22: 343-346.
[9] Ferroud V, Lapouge O, Dousseau A, et al. Flexible ureteroscopy and Mini percutaneous nephrolithotomy in the treatment of renal lithiasis ≤2 cm[J]. Prog Urol, 2011, 21: 79-84.
[10] 王炳卫,杨国胜,张福霖,等. 输尿管软镜与微创经皮肾镜治疗最大径2～3 cm肾结石的效果及对肾功能影响的比较[J].广东医学,2018,39(10):1525-1527.
[11] 苑海春,种 铁,薛玉泉.STONE评分与Guy分级预测经皮肾镜取石术结石清除率准确性的比较[J].武警医学,2019,30(1):42-50.
[12] 程 跃,严泽军,谢国海,等.“ 粉末化碎石” 在输尿管软镜治疗 肾结石中的应用[J].微创泌尿外科杂志,2013,23(3):210- 212.
[13] 石 英,张 悦,李 凯,等.经皮肾镜和输尿管软镜钬激光碎石分阶段处理复杂性肾结石临床探讨[J].重庆医学,2017,46(5):687-689.
[14] Egilmez T,Goren M. Predicting surgical outcome of percutaneous nephrolithotomy:validation of the guy,s stone score and nephrolithometricnomogram interms of success and complications [J].JCAM,2015,6(3):281-286.
[15] 雷光远,雷 鸣,刘永达,等. 微创经皮肾镜治疗孤立肾与非孤立 肾结石的比较[J].中华腔镜泌尿外科杂志( 电子版 ),2016,10(2):104 -107.
[16] 李创业,赵夭望,刘 李,等.输尿管软镜与微创经皮肾镜治疗儿童 ≥1.5 cm肾结石的对比研究[J].中华泌尿外科杂志,2018,39(5): 372-376.
PDF(745 KB)
