经皮肾镜与开放手术治疗复杂性肾结石临床疗效对比
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摘要
目的:比较经皮肾镜气压弹道超声碎石术与开放性手术治疗复杂性肾结石的疗效。方法:回顾性的研究了我院2003年至2008年经皮肾镜气压弹道超声碎石治疗47例与开放手术治疗30例复杂性肾结石的临床资料依据手术时间、术后住院天数、住院费用、结石清除率、手术并发症及出院及随访时肾功能改善情况,通过对所得数据统计分析,评价各自的优缺点。结果:PCNL出院时结石清石率78.72%(37/47),随访时的结石清石率87.50%(35/40)。开放手术出院时结石清石率56.67%(17/30),随访时的结石清石率68.00%(17/25)(出院p=0.039<0.05,随访p=0.056>0.05)。PCNL手术中并发症5例10.63%,开放手术并发症13例43.33%,术后并发症分别为10例21.27%,12例40.00%(术中p=0.006<0.05,术后p=0.013<0.05)。术中出血量PCNL平均为98.910ml,开放手术平均172.670ml,(u=4.246 p=0.000<0.05)手术时间PCNL平均1.960+0.470小时,开放手术平均2.080+0.250小时(p=0.309>0.05)。平均住院天数PCNL为20+3.7天,开放手术为26.57+4.8天。随访时的血清肌酐浓度3个月时76+18.084umol/l(44.790-132.860),开放手术3个月时125.310+33.278 umol/l( 280.230-87.120 ) (u=4.288 p=0.000<0.05)6个月时82.087+12.045 umol/l (112.370-61.077),99.828+18.258 umol/l (67.340-138.780()u=6.617 p=0.000<0.05)结论:经皮肾镜气压弹道超声碎石术治疗复杂性结石是一种非常有价值的选择,与开放手术相比其安全、有效、微创。但其费用较高,适合在经济条件较好的医院开展。
Objective: To investigate the clinic therapeutic effects of Percutaneous Nephrolithotomy in the treatment of complex renal nephrolithiasis,comparing with open surgery.Methods:Clinical application of percutaneous nephrolithotomy in 47cases and open surgery in 30 cases were analyzed retrospectively at our hospital from 2003 to 2008.The mean operation time ,cost and hospital stay,the stone clearance rate ,post and intra operation complications,and renal function progress at discharge home and follow up were compared.All complications were described.The dates were performed by statistical analysis.Results:The stone cleanrance rate at discharge in PCNL group is 78.72%(37/47), and 87.50%(35/40)at follow up. But the stone cleanrance rate of 56.67%(17/30), 68.00%(17/25)at discharge and follow up in open operation group respectively. (p=0.039<0.05,at discharge home between two groupes, and at follow up p=0.056>0.05).The intraoperational complications in 5 cases among PCNL group take 10.63%,and 13 cases in open operation take 43.33%. The postoperative complications in 10 cases (21.27%),and12 cases (40.00%)respectively(the intraoperative p=0.006<0.05,the post operative p=0.013<0.05). The intraoperative average blood losses are 98.910ml,and 172.670ml in open operation group. (u=4.246 p=0.000<0.05).The mean operation time are 1.960+0.470 hours for PCNL and 2.080+0.250 hours for open operation,respectively(t=0.309>0.05).The mean hospitalization are 20+3.7 days for PCNL,and 26.57+4.8days for open operation.The mean serum creatinine76+18.084umol/l(44.790-132.860)versus 125.310+33.278 umol/l(280.230-87.120)between PCNL group and open operation 3 months later at follow up, (u=4.288 p=0.000<0.05). Then 82.087+12.045 umol/l (112.37-61.077)for PCNL versus 99.828+18.258 umol/l (67.34-138.78)for open operation,(u=6.617 p=0.000<0.05)6 months later at follow up.Conclusions: PCNL is a valuable treatment option for complex renal calculi for its safety,effective and less damage,but its cost is higher than open surgery.So it is adapt to spread in excellent and good condition hospital.
Objective: To investigate the clinic therapeutic effects of Percutaneous Nephrolithotomy in the treatment of complex renal nephrolithiasis,comparing with open surgery.Methods:Clinical application of percutaneous nephrolithotomy in 47cases and open surgery in 30 cases were analyzed retrospectively at our hospital from 2003 to 2008.The mean operation time ,cost and hospital stay,the stone clearance rate ,post and intra operation complications,and renal function progress at discharge home and follow up were compared.All complications were described.The dates were performed by statistical analysis.Results:The stone cleanrance rate at discharge in PCNL group is 78.72%(37/47), and 87.50%(35/40)at follow up. But the stone cleanrance rate of 56.67%(17/30), 68.00%(17/25)at discharge and follow up in open operation group respectively. (p=0.039<0.05,at discharge home between two groupes, and at follow up p=0.056>0.05).The intraoperational complications in 5 cases among PCNL group take 10.63%,and 13 cases in open operation take 43.33%. The postoperative complications in 10 cases (21.27%),and12 cases (40.00%)respectively(the intraoperative p=0.006<0.05,the post operative p=0.013<0.05). The intraoperative average blood losses are 98.910ml,and 172.670ml in open operation group. (u=4.246 p=0.000<0.05).The mean operation time are 1.960+0.470 hours for PCNL and 2.080+0.250 hours for open operation,respectively(t=0.309>0.05).The mean hospitalization are 20+3.7 days for PCNL,and 26.57+4.8days for open operation.The mean serum creatinine76+18.084umol/l(44.790-132.860)versus 125.310+33.278 umol/l(280.230-87.120)between PCNL group and open operation 3 months later at follow up, (u=4.288 p=0.000<0.05). Then 82.087+12.045 umol/l (112.37-61.077)for PCNL versus 99.828+18.258 umol/l (67.34-138.78)for open operation,(u=6.617 p=0.000<0.05)6 months later at follow up.Conclusions: PCNL is a valuable treatment option for complex renal calculi for its safety,effective and less damage,but its cost is higher than open surgery.So it is adapt to spread in excellent and good condition hospital.
引文
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[8]钟健,侯健全.复杂性肾结石三种方法的比较[J].江苏医药,2008,34 (2):133-134.
[9]那彦群孙泽禹叶章群等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2007,255-256.
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[16] Abbas B,Seyed Amir MZ,Hamidreza Nasseh,et al.Totally Ultrasonography-Guided Percutaneous Nephrolithotomy in the Flank Position,Journal of endourology[J]. 2008(22) 7:1453-1457
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