标准通道和微通道PCNL对于治疗铸型肾结石的疗效比较
|
摘要
目的比较标准通道与微通道经皮肾碎石术对铸型肾结石的疗效
方法分析行微通道经皮肾碎石治疗74例和行标准通道经皮肾碎石治疗63例铸型肾结石的患者的临床资料,获取患者手术时间,一期结石清除率,术中术后是否出血,术后是否输血,术后是否有发热,术后造瘘管留置时间,住院天数等参数,将所得参数进行统计学分析,评价其优缺点。
结果微通道组与标准通道组对于铸型肾结石的一期结石清除率分别为：47.2%(35/74)和50.8%(32/63)；术后发热的例数分别为：6例和4例：术后出血例数分别为：2例和4例：术后输血数分别为：1例和1例,造瘘管留置时间分别为：5.1±2.3天和5.7±3.1天住院天数分别为：9.6±3.5天和10.2+4.3天,以上数据均无统计学差异(P>0.05),手术时间上标准通道组明显优于微通道组,具有统计学意义(P<0.05)
结论在处理体积较大的铸型肾结石方面,标准通道PCNL并没有增加并发症的发病率,但极大的缩短了手术时间,比较优于微通道PCNL。对于处理盏颈狭窄,肾盏较深的结石时,微通道较标准通道而言仍然有一定的优越性。
Objective To assess and compare the curative effects of standard-tract and mini-tract in treating renal staghorn Calculi.
Methods Clinical application of mini-tract PCNL in 74 cases and in 48 cases were analyzed.The operation time, the stone clearance rate, hospitalization time, and postoperative infections were compared. All complications were noted.The data was performed by statistical analysis.
Results In mini-tract PCNL and standard tract PCNL, the stone clearance rate was 47.2%(35/74) and 50.8%(32/63) respectively(P>0,05) the postoperative bleeding cases were 2 and 4 cases;(P>0.05) The infections were 6 and 4, respectively(P>0.05);the operation time were 116±13.7 and 78±15.6(P<0.05).
Conclusions Standard-tract PCNL had the same security as mini-tract PCNL,but it greatly shortened the operating time.In treating with relatively shorter diameter and branched renal Calculi.,MPCNL still had some advantages.
方法分析行微通道经皮肾碎石治疗74例和行标准通道经皮肾碎石治疗63例铸型肾结石的患者的临床资料,获取患者手术时间,一期结石清除率,术中术后是否出血,术后是否输血,术后是否有发热,术后造瘘管留置时间,住院天数等参数,将所得参数进行统计学分析,评价其优缺点。
结果微通道组与标准通道组对于铸型肾结石的一期结石清除率分别为：47.2%(35/74)和50.8%(32/63)；术后发热的例数分别为：6例和4例：术后出血例数分别为：2例和4例：术后输血数分别为：1例和1例,造瘘管留置时间分别为：5.1±2.3天和5.7±3.1天住院天数分别为：9.6±3.5天和10.2+4.3天,以上数据均无统计学差异(P>0.05),手术时间上标准通道组明显优于微通道组,具有统计学意义(P<0.05)
结论在处理体积较大的铸型肾结石方面,标准通道PCNL并没有增加并发症的发病率,但极大的缩短了手术时间,比较优于微通道PCNL。对于处理盏颈狭窄,肾盏较深的结石时,微通道较标准通道而言仍然有一定的优越性。
Objective To assess and compare the curative effects of standard-tract and mini-tract in treating renal staghorn Calculi.
Methods Clinical application of mini-tract PCNL in 74 cases and in 48 cases were analyzed.The operation time, the stone clearance rate, hospitalization time, and postoperative infections were compared. All complications were noted.The data was performed by statistical analysis.
Results In mini-tract PCNL and standard tract PCNL, the stone clearance rate was 47.2%(35/74) and 50.8%(32/63) respectively(P>0,05) the postoperative bleeding cases were 2 and 4 cases;(P>0.05) The infections were 6 and 4, respectively(P>0.05);the operation time were 116±13.7 and 78±15.6(P<0.05).
Conclusions Standard-tract PCNL had the same security as mini-tract PCNL,but it greatly shortened the operating time.In treating with relatively shorter diameter and branched renal Calculi.,MPCNL still had some advantages.
引文
[1]Ahlawat R,Banerjee GK,Dalela D. Bilateral simultaneous percutaneous nephrolithotomy. A prospective feasibility study.Eur Urol,1995,28 (2):116-118.
[2]Lahme S, Bichler KH, Strohmaier WL, et al. Minimally invasive PCNL in patients with renal pelvic and calyceal stones.European Urology,2001,40 (6):619-624
[3]Skolarikos et al. Percutaneous Nephrolithotomy and its Legacy.European Urology,2005,47:22-28.
[4]BK Auge,R Munver,J Kourambas,GE Newman,GM Preminger. Endoscopic management of symptomatic calyceal diverticula:a retrospective comparison of percutaneous nephrolithotomy and ureteroscopy.J Endourol.2002,16:557-563.
[5]Borin J F. Prone retrograde laser lithotripsy facilitates endoscope-guided percutaneous renal access for stag horn calculi:two scopes are better than one[J]. J Endourol,2008,22 (9):1881-1883.
[6]Kandasami S V,Rao R K,,Arul M,et al. Synchronous twin track percutaneous nephrolithotomy:A preliminary experi-ence[J].Indian J Urol,2008,24 (1):118-119.
[7]王志勇,于满,杨慧祥,马光,吴敬,徐辉.经皮肾镜标准通道下气压弹道-超声碎石清石系统治疗复杂性肾结石(附26例报告)[J].中国微创外科杂志,2010,(04)
[8]潘铁军.刘昊,沈国球.文瀚东,杨家荣,涂忠,郭骏.改良通道F20与标准通道F24经皮肾三代超声碎石临床疗效观察[J].现代泌尿外科杂志.2010,(04)
[9]Fanardzhian SV. [Complications of percutaneous nephrolithotripsy in staghorn nephrolithiasis] [J].Georgian Med News.2010 Oct;(187):7-12.
[10]Resorlu B, Kara C, Oguz U, Bayindir M, Unsal A. Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney. [J] Urol Res.2011 Jun:39(3):171-6. Epub 2010 Oct 22.
[1]Fraser,M,Joyce,AD,Thomas,DF,Eardley,I,Clark,PB. Minimally invasive treatment of urinary tract calculi in children.BJU Int,1999,84:339-342.
[2]Holman,E,Khan,AM,Pasztor,I,Toth,C. Simultaneous bilateral compared with unilateral percutaneous nephrolithotomy.BJU Int,2002,89:334-338.
[3]Ahlawat R,Banerjee GK,Dalela D. Bilateral simultaneous percutaneous nephrolithotomy. A prospective feasibility study.Eur Urol,1995,28 (2):116-118.
[4]Skolarikos et al. Percutaneous Nephrolithotomy and its Legacy.European Urology,2005,47:22-28.
[5]Lahme S. Bichler KH. Strohmaier WL, et al. Minimally invasive PCNL in patients with renal pelvic and calyceal stones.European Urology.2001.40 (6):619-624.
[6]BK Auge,R Munver,J Kourambas,GE Newman,GM Preminger. Endoscopic management of symptomatic calyceal diverticula:a retrospective comparison of percutaneous nephrolithotomy and ureteroscopy. J Endourol,2002,16:557-563.
[7]王树声,向松涛,陈志强,古炽明,白遵光,张策,王昭辉,李源.MPCN大功率钬激光碎石术治疗肾结石的疗效[J].广东医学,2005,(11)
[8]Maheshwari PN,Andankar M,Hedge S,Bansal M. Bilateral singlesession percutaneousnephrolithotomy:a feasible and safe treatment.J Endourol,2000,14 (3):285-287.
[9]Lahme S.,Lahme S,Bichler K H,et al. Minimally invasive PCNL(mini-pere).Alternative treatment modality or replacement of conventional PCNL[J].Urologe A,2008,47:563-568.
[10]Kumar R, Anand A, Saxena V, Seth A, Dogra PN, Gupta NP. Safety and efficacy of PCNL for management of staghorn calculi in pediatric patients[J]. J Pediatr Urol.2011 Apr 25
[11]Ray K. PCNL and staghorn kidney stones. Nat Rev Urol.2011 Mar;8(3):116.
[12]Zehri AA, Biyabani SR, Siddiqui KM, Memon A. Triggers of blood transfusion in percutaneous nephrolithotomy[J]. J Coll Physicians Surg Pak.2011 Mar;21 (3):138-41.
[13]Etemadian M, Soleimani MJ, Haghighi R, Zeighami MR, Najimi N. Does bleeding during percutaneous nephrolithotomy necessitate keeping the nephrostomy tube? A randomized controlled clinical trial[J]. Urol J.2011 Winter;8(1):21-6.
[14]Yuan H, Zheng S, Liu L, Han P, Wang J, Wei Q. The efficacy and safety of tubeless percutaneous nephrolithotomy:a systematic review and meta-analysis[J]. Urol Res.2011 Jan 30.
[15]Pevzner M, Stisser BC, Luskin J, Yeamans JC, Cheng-Lucey M, Pahira JJ. Alternative management of complex renal stones[J]. Int Urol Nephrol.2011 Jan 12.
[16]Akman T, Binbay M. Sari E, Yuruk E, Tepeler A, Akcay M, Muslumanoglu AY, Tefekli A. Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience[J]. J Endourol.2011 Feb;25(2):327-33. Epub 2011 Jan 8.
[17]Wang CJ, Chang CH, Huang SW. Simultaneous bilateral tubeless percutaneous nephrolithotomy of staghorn stones:a prospective randomized controlled study[J]. Urol Res.2010 Dec 16.
[18]Fanardzhian SV. [Complications of percutaneous nephrolithotripsy in staghorn nephrolithiasis] [J].Georgian Med News.2010 Oct;(187):7-12.
[19]Resorlu B, Kara C, Oguz U, Bayindir M. Unsal A. Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney. [J] Urol Res.2011 Jun;39(3):171-6. Epub 2010 Oct 22.
[20]Ye ZQ,Kong DB,Chen ZQ,et al. Stable expression of the oxc and frc genes from oxalobacter formigenes in human embryo kidney293cells:im-plications for gene therapy of hyperoxaluria[J].Int J Mol Med,2007,20 (4):521-526.
[21]付明,熊文清.谈昌宾.超声联合气压弹道碎石术治疗复杂性肾结石(附78例报 道)[J].临床泌尿外科杂志,2006,(11).
[22]曾定胜,孙先禹,何俊.经皮肾镜取石术治疗肾结石(附219例报告)[J].华西医学,2008,(06).
[23]夏宏辉,张轶庠,李文杰,叶琪辉,方建明,虞晓勇,谢磊.微创经皮肾穿刺造瘘取石术治疗复杂肾结石(附192例报告)[J].中国医师杂志,2006,(04)
[24]张明庆.标准通道和微通道经皮肾镜术对猪孤立肾损伤的评估[D].青岛大学,2009
[25]李敏,李春生,黎峰云,熊飞龙.B超引导下应用第四代EMS气压弹道联合超声碎石清石系统治疗肾结石69例疗效分析[J].中国实用医药,2010,(16)
[26]潘铁军,刘昊,沈国球,文瀚东,杨家荣,涂忠,郭骏.改良通道F20与标准通道F24经皮肾三代超声碎石临床疗效观察[J].现代泌尿外科杂志,2010,(04)
[27]Fernstrorn I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol.1976:10:257-259.
[28]Agrawal MS.Agrawal M et al. A randomized comparison of tubeless and standard percutaneous nephrolithotomy.J Endourol,2008,22 (3):439-42
[2]Lahme S, Bichler KH, Strohmaier WL, et al. Minimally invasive PCNL in patients with renal pelvic and calyceal stones.European Urology,2001,40 (6):619-624
[3]Skolarikos et al. Percutaneous Nephrolithotomy and its Legacy.European Urology,2005,47:22-28.
[4]BK Auge,R Munver,J Kourambas,GE Newman,GM Preminger. Endoscopic management of symptomatic calyceal diverticula:a retrospective comparison of percutaneous nephrolithotomy and ureteroscopy.J Endourol.2002,16:557-563.
[5]Borin J F. Prone retrograde laser lithotripsy facilitates endoscope-guided percutaneous renal access for stag horn calculi:two scopes are better than one[J]. J Endourol,2008,22 (9):1881-1883.
[6]Kandasami S V,Rao R K,,Arul M,et al. Synchronous twin track percutaneous nephrolithotomy:A preliminary experi-ence[J].Indian J Urol,2008,24 (1):118-119.
[7]王志勇,于满,杨慧祥,马光,吴敬,徐辉.经皮肾镜标准通道下气压弹道-超声碎石清石系统治疗复杂性肾结石(附26例报告)[J].中国微创外科杂志,2010,(04)
[8]潘铁军.刘昊,沈国球.文瀚东,杨家荣,涂忠,郭骏.改良通道F20与标准通道F24经皮肾三代超声碎石临床疗效观察[J].现代泌尿外科杂志.2010,(04)
[9]Fanardzhian SV. [Complications of percutaneous nephrolithotripsy in staghorn nephrolithiasis] [J].Georgian Med News.2010 Oct;(187):7-12.
[10]Resorlu B, Kara C, Oguz U, Bayindir M, Unsal A. Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney. [J] Urol Res.2011 Jun:39(3):171-6. Epub 2010 Oct 22.
[1]Fraser,M,Joyce,AD,Thomas,DF,Eardley,I,Clark,PB. Minimally invasive treatment of urinary tract calculi in children.BJU Int,1999,84:339-342.
[2]Holman,E,Khan,AM,Pasztor,I,Toth,C. Simultaneous bilateral compared with unilateral percutaneous nephrolithotomy.BJU Int,2002,89:334-338.
[3]Ahlawat R,Banerjee GK,Dalela D. Bilateral simultaneous percutaneous nephrolithotomy. A prospective feasibility study.Eur Urol,1995,28 (2):116-118.
[4]Skolarikos et al. Percutaneous Nephrolithotomy and its Legacy.European Urology,2005,47:22-28.
[5]Lahme S. Bichler KH. Strohmaier WL, et al. Minimally invasive PCNL in patients with renal pelvic and calyceal stones.European Urology.2001.40 (6):619-624.
[6]BK Auge,R Munver,J Kourambas,GE Newman,GM Preminger. Endoscopic management of symptomatic calyceal diverticula:a retrospective comparison of percutaneous nephrolithotomy and ureteroscopy. J Endourol,2002,16:557-563.
[7]王树声,向松涛,陈志强,古炽明,白遵光,张策,王昭辉,李源.MPCN大功率钬激光碎石术治疗肾结石的疗效[J].广东医学,2005,(11)
[8]Maheshwari PN,Andankar M,Hedge S,Bansal M. Bilateral singlesession percutaneousnephrolithotomy:a feasible and safe treatment.J Endourol,2000,14 (3):285-287.
[9]Lahme S.,Lahme S,Bichler K H,et al. Minimally invasive PCNL(mini-pere).Alternative treatment modality or replacement of conventional PCNL[J].Urologe A,2008,47:563-568.
[10]Kumar R, Anand A, Saxena V, Seth A, Dogra PN, Gupta NP. Safety and efficacy of PCNL for management of staghorn calculi in pediatric patients[J]. J Pediatr Urol.2011 Apr 25
[11]Ray K. PCNL and staghorn kidney stones. Nat Rev Urol.2011 Mar;8(3):116.
[12]Zehri AA, Biyabani SR, Siddiqui KM, Memon A. Triggers of blood transfusion in percutaneous nephrolithotomy[J]. J Coll Physicians Surg Pak.2011 Mar;21 (3):138-41.
[13]Etemadian M, Soleimani MJ, Haghighi R, Zeighami MR, Najimi N. Does bleeding during percutaneous nephrolithotomy necessitate keeping the nephrostomy tube? A randomized controlled clinical trial[J]. Urol J.2011 Winter;8(1):21-6.
[14]Yuan H, Zheng S, Liu L, Han P, Wang J, Wei Q. The efficacy and safety of tubeless percutaneous nephrolithotomy:a systematic review and meta-analysis[J]. Urol Res.2011 Jan 30.
[15]Pevzner M, Stisser BC, Luskin J, Yeamans JC, Cheng-Lucey M, Pahira JJ. Alternative management of complex renal stones[J]. Int Urol Nephrol.2011 Jan 12.
[16]Akman T, Binbay M. Sari E, Yuruk E, Tepeler A, Akcay M, Muslumanoglu AY, Tefekli A. Factors affecting bleeding during percutaneous nephrolithotomy: single surgeon experience[J]. J Endourol.2011 Feb;25(2):327-33. Epub 2011 Jan 8.
[17]Wang CJ, Chang CH, Huang SW. Simultaneous bilateral tubeless percutaneous nephrolithotomy of staghorn stones:a prospective randomized controlled study[J]. Urol Res.2010 Dec 16.
[18]Fanardzhian SV. [Complications of percutaneous nephrolithotripsy in staghorn nephrolithiasis] [J].Georgian Med News.2010 Oct;(187):7-12.
[19]Resorlu B, Kara C, Oguz U, Bayindir M. Unsal A. Percutaneous nephrolithotomy for complex caliceal and staghorn stones in patients with solitary kidney. [J] Urol Res.2011 Jun;39(3):171-6. Epub 2010 Oct 22.
[20]Ye ZQ,Kong DB,Chen ZQ,et al. Stable expression of the oxc and frc genes from oxalobacter formigenes in human embryo kidney293cells:im-plications for gene therapy of hyperoxaluria[J].Int J Mol Med,2007,20 (4):521-526.
[21]付明,熊文清.谈昌宾.超声联合气压弹道碎石术治疗复杂性肾结石(附78例报 道)[J].临床泌尿外科杂志,2006,(11).
[22]曾定胜,孙先禹,何俊.经皮肾镜取石术治疗肾结石(附219例报告)[J].华西医学,2008,(06).
[23]夏宏辉,张轶庠,李文杰,叶琪辉,方建明,虞晓勇,谢磊.微创经皮肾穿刺造瘘取石术治疗复杂肾结石(附192例报告)[J].中国医师杂志,2006,(04)
[24]张明庆.标准通道和微通道经皮肾镜术对猪孤立肾损伤的评估[D].青岛大学,2009
[25]李敏,李春生,黎峰云,熊飞龙.B超引导下应用第四代EMS气压弹道联合超声碎石清石系统治疗肾结石69例疗效分析[J].中国实用医药,2010,(16)
[26]潘铁军,刘昊,沈国球,文瀚东,杨家荣,涂忠,郭骏.改良通道F20与标准通道F24经皮肾三代超声碎石临床疗效观察[J].现代泌尿外科杂志,2010,(04)
[27]Fernstrorn I, Johansson B. Percutaneous pyelolithotomy. A new extraction technique. Scand J Urol Nephrol.1976:10:257-259.
[28]Agrawal MS.Agrawal M et al. A randomized comparison of tubeless and standard percutaneous nephrolithotomy.J Endourol,2008,22 (3):439-42