摘要
目的探讨肋上通道经皮肾镜取石术(PCNL)治疗鹿角形肾结石的安全性及临床疗效。方法 2009年6月—2011年6月我院泌尿外科微创PCNL治疗鹿角形肾结石患者85例,其中40例采用肋上通道PCNL(A组),45例采用肋下通道PCNL(B组),对比分析两组患者手术时间、清石率以及并发症发生情况。结果 85例患者均采用微创PCNL治疗,无改开放手术。A组手术时间60～135 min,平均(70.2±12.3)min,2例患者术后尿路平片示残余结石,需进一步行体外碎石处理,清石率为95.0%(38/40)。B组手术时间85～140 min,平均(90.2±13.5)min,其中2例患者为双通道碎石,3例患者为三通道碎石;3例患者术后需体外冲击波碎石治疗,2例患者需二次手术碎石,清石率为88.9%(40/45);2例患者术中出血较多,术中给予输浓缩红细胞2 U,2例患者术后发热。A组手术时间较B组明显缩短,差异有统计学意义(t=4.20,P<0.05);A组清石率较B组明显升高,差异有统计学意义(χ2=125.3,P<0.05)。两组患者均未出现脏器损伤、胸部并发症等严重并发症。结论与肋下通道PCNL相比,肋上通道PCNL治疗鹿角形肾结石手术时间短、清石率高且无明显并发症发生,临床效果显著。
Objective To explore the safety and efficacy of supracostal approach PCNL in the treatment of staghorn renal stones.Methods From June 2009 to June 2011,85 patients of staghorn renal calculi were treated in our hospital.Of these,40 patients were treated by supracostal PCNL（group A） and 45 by subcostal approach（group B）.The operation time,stone-free rate and complications were compared between the two groups.Results All 85 cases had PCNL operation without changing to open surgery.Operation time in group A was 60~135 min,with average time of（70.2±12.3）min.2 patients′ KUB showed remnant stones,and the stone-free rate was 95%（38/40）.In group B,the operation time was 85~140 min,with average time of（90.2±13.5）min.2 cases dispersed stones by double channels,3 cases dispersed stones by triple channels.3 cases had their stones dispersed by extracorporeal shock wave,2 cases need second time operation.The stone-free rate was 88.9%（40/45）.2 cases transfused RBC 2 U for bleeding during operation and 2 patients had a fever after operation.The operation time of group A was significantly shorter than that of group B（t=4.20,P0.05）.The stone-free rate of group A was significantly higher than that of group B（χ2=125.3,P0.05）.Both group A and B had no significant complications like visceral organ injury and chest complications.Conclusion PCNL via supracostal access in the treatment of staghorn stones is safe and effective with shorter operation time and higher stone-free rate compared with subcostal access.
出处
《中国全科医学》
CAS
CSCD
北大核心
2012年第15期1759-1761,共3页
Chinese General Practice
关键词
肾造口术
经皮
肾结石
治疗结果
Nephrostomy
percutaneous
Kidney calculi
Treatment outcome
