B超引导下标准通道经皮肾镜取石术与开放手术取石术的疗效比较

目的比较B超引导下标准通道经皮肾镜取石术(PCNL)与开放手术取石术治疗肾结石的临床疗效。方法将492例肾结石患者,按照2∶1的配对分组方法分为PCNL组328例和对照组164例,PCNL组行B超引导下标准通道经皮肾镜取石术,对照组采用开放手术取石术,分别观察两组手术时间、术中出血、伤口大小、术后情况、手术并发症及动脉血流动力学变化等指标,并进行比较分析。结果治疗组术后1个月结石清除率为89.3%,显著高于对照组的78.0%(P<0.01);PCNL组手术时间短于对照组,术中出血量少于对照组,伤口小于对照组,比较差异有统计学意义(P<0.01)。术前、术后1个月及术后3个月两组肾主动脉、段间动脉、叶间动脉R I值等动脉血流动力学指标比较,差异均无统计学意义(P均>0.05)。PCNL组肾结石伴肾功能不全患者术后3个月的肾功能好于对照组(P<0.05)。结论 B超引导下标准通道经皮肾镜取石术的并发症发生率低,对伴有肾功能不全结石患者术后近期肾功能均无明显影响,是一种创伤小、安全性高、恢复快的治疗手段。

Comparative efficacy between standard tract percutaneoas nephrolithotomy with B ultrasound and open nephrolithotomy

Objective To compare the clinical efficacy of standard-tract percutaneous nephrolithotomy（PCNL） with B ultrasound and open nephrolithotomy.Methods 492 patients with kidney calculus were divided into PCNL group（n=328） and control group（n=164） with the ratio of 2∶1.The patients in PCNL group were treated with standard tract percutaneous nephrolithotomy（PCNL） with B ultrasound;and the patients in the control group were submitted to open nephrolithotomy.Operative time,blood loss,size of wound,postoperative conditions,complications and hemodynamic alterations for the patients in both groups were observed and compared.Results The stone clearance rate of the treated group 1 month after operation was 89.3%,obviously higher than 78.0% of the control group（P0.01）.The operation time for the treated group with less hemorrhage and smaller wound was also shorter than that of the control group,showing significant difference（P0.01）.1 month before and after operation,and 3 months after operation,there was no significant difference of RI value of MRA,SRA and IRA between the two groups（both P0.05）.3 months after operation,PCNL group with kidney stone and renal insufficiency had better renal function than the control group（P0.05）.Conclusion Standard-tract percutaneous nephrolithotomy（PCNL）with B ultrasound has a low incidence of complications,and no significant effect on postoperative patients with calculus of kidney and renal insufficiency in the near future.It is a minimally invasive,safe treatment method with rapid recovery.