膀胱软镜联合经皮肾镜治疗复杂性肾结石中的临床疗效及预后分析

doi:10.3969/j.issn.1005-6483.2020.07.024

摘要/Abstract

摘要： 目的探讨经皮肾镜联合膀胱软镜治疗复杂性肾结石的疗效。
方法 2018年6月～2019年6月我科收治的复杂性结石病人78例，根据治疗方法不同分为两组，联合组36例，经皮肾镜组42例。比较两组病人的手术时间、住院时间，术中出血，经皮肾镜通道数量，术后5天和1个月结石清除率，Ⅱ期碎石发生率及围手术期并发症发生率，评估病人的满意度。
结果两组病人均成功完成手术，联合组平均手术时间（136.32±12.54）分钟，平均住院时间（7.02±0.84）天，平均术中出血为（74.29±7.17）ml，Ⅱ期碎石发生率为2.7%（1/36）；经皮肾镜组平均手术时间（120.28±14.62）分钟，平均住院时间（7.10±0.96）天，平均术中出血为（75.23±6.18）ml，Ⅱ期碎石发生率为23.80%（10/42）。联合组手术时间常长于经皮肾镜组，Ⅱ期碎石发生率少于经皮肾镜组，差异有统计学意义（P＜0.05）。两组住院时间、经皮肾镜通道数量和术中出血比较差异无统计学意义（P＞0.05）。联合组的术后5天结石清除率为91.7%（33/36），术后1个月结石清除率为97.2%（35/36），经皮肾镜组分别为69.0%（29/42）和76.2%（32/42），两组比较差异有统计学意义（P＜0.05）。联合组总并发症为16.66%（6/36），经皮肾镜组为38.09%（16/42），两组比较差异有统计学意义（P＜0.05）。联合组病人满意度比经皮肾镜组高，差异有统计学意义（P＜0.05）。
结论经皮肾镜联合膀胱软镜治疗复杂性肾结石具有良好的效果和安全性。

关键词: 膀胱软镜, 经皮肾镜, 复杂性肾结石, 钬激光碎石术

Abstract: Objective The efficacy of percutaneous nephrolithotomy combined with flexible cystoscopy in complicated renal calculi was explored.
Methods We collected 78 patients with complicated stones in our department from June 2018 to June 2019，including 36 patients in the combined group and 42 patients in the percutaneous nephrolithotomy group.All patients were anesthetized by general anesthesia.The intraoperative operative time，hospital stay，intraoperative bleeding，and number of percutaneous nephroscopic channels were compared between the two groups.The stone clearance rate at 5 days and 1 month after surgery，the incidence of stage Ⅱ lithotripsy，and the incidence of perioperative complications were evaluated.
Results The operation was successful in both groups.The average operation time of the combined group was 136.32±12.54min，the average hospitalization time was 7.02±0.84 d，the average intraoperative blood loss was 74.29±7.17 ml，and the incidence of stage Ⅱ lithotripsy was 2.7%（1/36）.The average operation time of percutaneous nephrolithotomy was 120.28±14.62 min，the average hospitalization time was 7.10±0.96 d，the average intraoperative blood loss was 75.23±6.18ml，and the incidence of stage Ⅱlithotripsy was 23.80%（10/42）.The operation time of the combined group was often longer than that of the percutaneous nephrolithotomy group.The incidence of stage Ⅱ lithotripsy was lower than that of the percutaneous nephrolithotomy group，the difference was statistically significant（P<0.05）.There was no difference in hospitalization time，number of percutaneous nephroscopic channels and intraoperative bleeding between the two groups.Statistical significance（P>0.05），The 5d stone clearance rate was 91.7%（33/36）in the combined group，97.2%（35/36）in the postoperative month，and 69.0% in the percutaneous nephrolithotomy./42），the stone clearance rate was 76.2%（32/42）in January，and the difference was statistically significant（P<0.05）.The total complication of the combined group was 16.66%（6/36），and the total complication of the percutaneous nephrolithotomy group was 38.09%（16/42）.The difference between the two groups was statistically significant（P<0.05）.The degree was higher than that in the percutaneous nephrolithotomy group，and the difference was statistically significant（P<0.05）.
Conclusion In the treatment of complex kidney stones，percutaneous nephrolithotomy combined with flexible cystoscopy surgery has good effect and safety，and it is worthy of clinical application.

Key words: flexible cystoscopy, percutaneous nephrolithotomy, complicated renal calculus, holmium laser lithotripsy

熊波波张劲松李宁王海峰左毅刚. 膀胱软镜联合经皮肾镜治疗复杂性肾结石中的临床疗效及预后分析[J]. 临床外科杂志, 2020, 28(7): 678-681.

XIONG Bobo, ZHANG Jinsong, LI Ning, et al.. Efficacy and prognosis of flexible cystoscopy combined with percutaneous nephrolithotomy in complicated renal calculi[J]. JOURNAL OF CLINICAL SURGERY, 2020, 28(7): 678-681.

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