标准通道与微通道经皮肾镜碎石取石术治疗肾结石的疗效分析(附视频)

目的 探讨标准通道经皮肾镜取石术(PCNL)与微通道经皮肾镜取石术(MPCNL)治疗肾结石的临床疗效及其优缺点.方法 回顾性分析323例肾结石患者,其中178例采用MPCNL,145例采用标准通道PCNL,对两组手术时间、一期手术成功率、结石清除率、手术并发症、肾功能、输血率、住院时间等指标进行比较分析.结果 两组患者分别成功建立了18 F和24 F肾穿刺通道并一期行碎石术.MPCNL组手术时间较PCNL组延长(P＜0.05),但肾盏多发性结石患者结石清除率高于标准通道PCNL组(P＜0.05),而单纯肾盂结石患者结石清除率则低于标准通道PCNL组(P＜0.05).两组鹿角型结石患者一期结石清除率比较无统计学意义(P＞0.05).两组术后手术并发症、肾功能、输血率、住院时间等均无显著性差异(P＞0.05).结论 MPCNL与标准通道PCNL均具有术中损伤小、住院时间短、结石清除率高、并发症低、对肾功能无明显影响等优点.标准通道PCNL较适合处理较大的肾盂结石,MPCNL较适合治疗肾盏多发结石,两者联合应用可提高鹿角型结石的治疗疗效.

Comparison of clinical effect between PCNL and MPCNL in the treatment of renal calculi

Objective To compare the efficacy and advantages of standard percutaneous nephrolithotomy (PCNL) and mini-percutaneous nephrolithotomy (MPCNL) in the treatment of renal calculi. Methods A retrospective analysis about clinic data of 323 patients with renal calculi treated during Jan. 2009 to Dec. 2011 were summarized and analyzed. PCNL was performed in 145 patients and MPCNL in 178 patients. The operation time, success rate, stone-free rate, complications, renal function, blood transfusion, and postoperative hospital stay were compared. Results 18 F and 24 F percutaneous renal access were successfully established in PCNL and MPCNL group respectively. The MPCNL group had a longer operation time than the PCNL group. The one-stage stone-free rate for multiple stones was significantly higher in the MPCNL group than that in the PCNL group. However, the stone-free rate for simple renal pelvis stone was significantly lower in the MPCNL group than that in the PCNL group. There was no statistical difference in one-stage stone-free rate, complications rate, renal function, blood transfusion, and postoperative hospital stay between the two groups for staghorn stone. Conclusions Both PCNL and MPCNL have the advantages of shorter hospital stay, quick recovery, higher stone clearance rate and fewer complications. Standard tract PCNL may be suitable for large renal stone, while MPCNL may has advantages in the treatment for renal calyx stone.