超微经皮肾镜治疗上尿路结石的体会
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摘要
目的研究并探讨超微经皮肾镜取石术(micro-PCNL)治疗上尿路结石的临床效果及及体会。方法选择2014年5月~2016年1月我院收治的上尿路结石患者作为此次研究的对象,采用micro-PCNL作为观察组(n=50),采用常规经皮肾镜取石术患者作为对照组(n=50),观察两组患者的手术成功率、一期碎石清除率、住院时间、VAS疼痛评分以及并发症发生情况。结果两组手术均成功完成,观察组的一期碎石清除率为96%,明显高于对照组的80%(P<0.05);与对照组相比,观察组患者的住院时间明显缩短(P<0.05),VAS疼痛评分明显更低(P<0.05)。观察组患者术后未出现明显并发症,对照组有5例并发症发生,包括3例尿血,2例感染,均保守治疗痊愈。结论采用micro-PCNL治疗上尿路结石可有效清除结石、缩短住院时间、减轻术后疼痛、减少并发症的发生。
Objective To discuss the clinical effect of micro-percutaneous nephrolithotomy(micro-PCNL) in treatment of upper urinary tract calculi. Methods Fifty patients admitted from May2014 to March 2016 in our hospital were selected and underwent micro-PCNL for treatment of upper urinary tract stones(micro-PCNL group). Another 50 patients with upper urinary tract stones who received conventional percutaneous renal stone removal served as controls. The operation success rate,debris removal rate, length of stay, VAS pain score and complications were compared between the two groups. Results All operation were completed successfully. The rate of debris removal in micro-PCNL group was 96%, and 80% in the control group(micro-PCNL group vs control group,P<0.05).Compared with the control group, the hospitalization time of micro-PCNL group was significantly shorter(P<0.05), and the VAS pain score was significantly lower(P<0.05). No severe complications occurred in micro-PCNL group, and five cases in control group which were Urinary infection in 3cases and bloody urine in 2 cases. Conclusion In the present study, micro-PCNL showed obvious curative effect, shorter hospital stay and less complications.
Objective To discuss the clinical effect of micro-percutaneous nephrolithotomy(micro-PCNL) in treatment of upper urinary tract calculi. Methods Fifty patients admitted from May2014 to March 2016 in our hospital were selected and underwent micro-PCNL for treatment of upper urinary tract stones(micro-PCNL group). Another 50 patients with upper urinary tract stones who received conventional percutaneous renal stone removal served as controls. The operation success rate,debris removal rate, length of stay, VAS pain score and complications were compared between the two groups. Results All operation were completed successfully. The rate of debris removal in micro-PCNL group was 96%, and 80% in the control group(micro-PCNL group vs control group,P<0.05).Compared with the control group, the hospitalization time of micro-PCNL group was significantly shorter(P<0.05), and the VAS pain score was significantly lower(P<0.05). No severe complications occurred in micro-PCNL group, and five cases in control group which were Urinary infection in 3cases and bloody urine in 2 cases. Conclusion In the present study, micro-PCNL showed obvious curative effect, shorter hospital stay and less complications.
引文
[1]Bryniarski P,Paradysz A,Zyczkowski M,et al.A randomized controlled study to analyze the safety and efficacy of percutaneous nephrolithotripsy and retrograde intrarenal surgery in the management of renal stones more than 2 cm in diameter[J].J Endourol,2012,26(1):52-57.
[2]Tepeler A,Akman T,Silay MS,et al.Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy[J].Urolithiasis,2014,42(3):275-279.
[3]Preminger GM.Micro-percutaneous nephrolithotomy(microPNL)vs retrograde intra-renal surgery(RIRS):dealer's choice?The devil is in the details[J].BJU Int,2013,112(3):280-281.
[4]冯钢,苏泽轩,李逊,等.微创经皮肾镜取石术的应用解剖及其临床应用[J].中国临床解剖学杂志,2004,22(4):432-434.
[5]李虎林,刘春晓,徐啊白,等.局麻下经皮肾镜取石术治疗上尿路结石1363例报告[J].中华泌尿外科杂志,2011,32(8):525-527.
[6]He Y,Li NN,Chen Z,et al.Retroperitoneal laparoendoscopic single-site ureterolithotomy for upper ureteral stone disease[J].Scand J Urol,2013,47(6):515-520.
[7]Matlaga BR;American Board of Urology.Contemporary surgical management of upper urinary tract calculi[J].J Urol,2009,181(5):2152-2156.
[8]Matlaga BR,Meckley LM,Kim M,et al.Management patterns of medicare patients undergoing treatment for upper urinary tract calculi[J].J Endourol,2014,28(6):723-728.
[9]Fernandez A,Foell K,Nott L,et al.Percutaneous nephrolithotripsy in patients with urinary diversions:a casecontrol comparison of perioperative outcomes[J].J Endourol,2011,25(10):1615-1618.
[10]刘成倍,徐伟,廖春华.微创经皮肾镜取石术治疗上尿路结石合并感染的临床研究[J].中华医院感染学杂志,2014,24(1):162-164.
[11]Akman T,Binbay M,Ozgor F,et al.Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones:a matched-pair analysis[J].BJU int,2012,109(9):1384-1389.
[12]曾国华,万肖蓬,陈文忠,等.超微经皮肾镜取石术治疗31例肾结石的初步体会[J].中华泌尿外科杂志,2014,35(1):6-9.
[2]Tepeler A,Akman T,Silay MS,et al.Comparison of intrarenal pelvic pressure during micro-percutaneous nephrolithotomy and conventional percutaneous nephrolithotomy[J].Urolithiasis,2014,42(3):275-279.
[3]Preminger GM.Micro-percutaneous nephrolithotomy(microPNL)vs retrograde intra-renal surgery(RIRS):dealer's choice?The devil is in the details[J].BJU Int,2013,112(3):280-281.
[4]冯钢,苏泽轩,李逊,等.微创经皮肾镜取石术的应用解剖及其临床应用[J].中国临床解剖学杂志,2004,22(4):432-434.
[5]李虎林,刘春晓,徐啊白,等.局麻下经皮肾镜取石术治疗上尿路结石1363例报告[J].中华泌尿外科杂志,2011,32(8):525-527.
[6]He Y,Li NN,Chen Z,et al.Retroperitoneal laparoendoscopic single-site ureterolithotomy for upper ureteral stone disease[J].Scand J Urol,2013,47(6):515-520.
[7]Matlaga BR;American Board of Urology.Contemporary surgical management of upper urinary tract calculi[J].J Urol,2009,181(5):2152-2156.
[8]Matlaga BR,Meckley LM,Kim M,et al.Management patterns of medicare patients undergoing treatment for upper urinary tract calculi[J].J Endourol,2014,28(6):723-728.
[9]Fernandez A,Foell K,Nott L,et al.Percutaneous nephrolithotripsy in patients with urinary diversions:a casecontrol comparison of perioperative outcomes[J].J Endourol,2011,25(10):1615-1618.
[10]刘成倍,徐伟,廖春华.微创经皮肾镜取石术治疗上尿路结石合并感染的临床研究[J].中华医院感染学杂志,2014,24(1):162-164.
[11]Akman T,Binbay M,Ozgor F,et al.Comparison of percutaneous nephrolithotomy and retrograde flexible nephrolithotripsy for the management of 2-4 cm stones:a matched-pair analysis[J].BJU int,2012,109(9):1384-1389.
[12]曾国华,万肖蓬,陈文忠,等.超微经皮肾镜取石术治疗31例肾结石的初步体会[J].中华泌尿外科杂志,2014,35(1):6-9.