中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
11期
31-34
,共4页
肾结石%肾机能不全%肾造口术,经皮%外科手术,微创性
腎結石%腎機能不全%腎造口術,經皮%外科手術,微創性
신결석%신궤능불전%신조구술,경피%외과수술,미창성
Kidney calculi%Renal insufficiency%Nephrostomy,percutaneous%Surgical procedures,minimally invasive
目的 探讨微创经皮肾镜碎石取石术(mPCNL)治疗肾结石疗效及对肾功能的影响.方法 将70例肾结石患者按手术方式不同分为mPCNL组(38例)和经皮肾镜碎石取石术(PCNL)组(32例),观察两组治疗疗效及术前和术后1个月血肌酐和尿素氮的变化.结果 两组患者均成功完成一期碎石,PCNL组鹿角形结石、单纯性肾盂结石及肾盏多发性结石的手术时间均短于mPCNL组[(89.13±13.36) min比(112.32±12.41) min、(65.28±9.76) min比(78.84±12.03) min、(98.97±l1.84) min比(112.64± 10.87) min,P＜0.05]；PCNL组单纯性肾盂结石一期清除率高于mPCNL组[88.89％(8/9)比57.14％(8/14),P＜ 0.05],肾盏多发性结石一期清除率低于mPCNL组[58.33％(7/12)比86.67％(13/15),P＜0.05],两组鹿角形结石一期清除率比较差异无统计学意义[63.64％(7/11)比66.67％(6/9),P＞0.05].两组患者均未发生严重并发症,PCNL组和mPCNL组术后发热发生率比较差异无统计学意义[15.63％(5/32)比10.53％(4/38),P＞ 0.05].两组肾结石合并肾功能不全患者术后血肌酐、尿素氮较术前稍有下降,但术前与术后比较差异无统计学意义(P＞0.05)；两组术后肾功能改善率比较差异无统计学意义(P＞0.05).结论 mPCNL及PCNL治疗肾结石均能达到较好的一期结石清除率,术后并发症发生率低,对术后早期肾功能无明显影响,mPCNL较PCNL手术时间普遍延长,但对肾盏多发性结石治疗效果优于PCNL.
目的 探討微創經皮腎鏡碎石取石術(mPCNL)治療腎結石療效及對腎功能的影響.方法 將70例腎結石患者按手術方式不同分為mPCNL組(38例)和經皮腎鏡碎石取石術(PCNL)組(32例),觀察兩組治療療效及術前和術後1箇月血肌酐和尿素氮的變化.結果 兩組患者均成功完成一期碎石,PCNL組鹿角形結石、單純性腎盂結石及腎盞多髮性結石的手術時間均短于mPCNL組[(89.13±13.36) min比(112.32±12.41) min、(65.28±9.76) min比(78.84±12.03) min、(98.97±l1.84) min比(112.64± 10.87) min,P＜0.05]；PCNL組單純性腎盂結石一期清除率高于mPCNL組[88.89％(8/9)比57.14％(8/14),P＜ 0.05],腎盞多髮性結石一期清除率低于mPCNL組[58.33％(7/12)比86.67％(13/15),P＜0.05],兩組鹿角形結石一期清除率比較差異無統計學意義[63.64％(7/11)比66.67％(6/9),P＞0.05].兩組患者均未髮生嚴重併髮癥,PCNL組和mPCNL組術後髮熱髮生率比較差異無統計學意義[15.63％(5/32)比10.53％(4/38),P＞ 0.05].兩組腎結石閤併腎功能不全患者術後血肌酐、尿素氮較術前稍有下降,但術前與術後比較差異無統計學意義(P＞0.05)；兩組術後腎功能改善率比較差異無統計學意義(P＞0.05).結論 mPCNL及PCNL治療腎結石均能達到較好的一期結石清除率,術後併髮癥髮生率低,對術後早期腎功能無明顯影響,mPCNL較PCNL手術時間普遍延長,但對腎盞多髮性結石治療效果優于PCNL.
목적 탐토미창경피신경쇄석취석술(mPCNL)치료신결석료효급대신공능적영향.방법 장70례신결석환자안수술방식불동분위mPCNL조(38례)화경피신경쇄석취석술(PCNL)조(32례),관찰량조치료료효급술전화술후1개월혈기항화뇨소담적변화.결과 량조환자균성공완성일기쇄석,PCNL조록각형결석、단순성신우결석급신잔다발성결석적수술시간균단우mPCNL조[(89.13±13.36) min비(112.32±12.41) min、(65.28±9.76) min비(78.84±12.03) min、(98.97±l1.84) min비(112.64± 10.87) min,P＜0.05]；PCNL조단순성신우결석일기청제솔고우mPCNL조[88.89％(8/9)비57.14％(8/14),P＜ 0.05],신잔다발성결석일기청제솔저우mPCNL조[58.33％(7/12)비86.67％(13/15),P＜0.05],량조록각형결석일기청제솔비교차이무통계학의의[63.64％(7/11)비66.67％(6/9),P＞0.05].량조환자균미발생엄중병발증,PCNL조화mPCNL조술후발열발생솔비교차이무통계학의의[15.63％(5/32)비10.53％(4/38),P＞ 0.05].량조신결석합병신공능불전환자술후혈기항、뇨소담교술전초유하강,단술전여술후비교차이무통계학의의(P＞0.05)；량조술후신공능개선솔비교차이무통계학의의(P＞0.05).결론 mPCNL급PCNL치료신결석균능체도교호적일기결석청제솔,술후병발증발생솔저,대술후조기신공능무명현영향,mPCNL교PCNL수술시간보편연장,단대신잔다발성결석치료효과우우PCNL.
Objective To investigate the therapeutic effect of minimally invasive percutaneous nephrostolithotomy (mPCNL) in treatment of kidney calculi and the influence of renal function.Methods According to the operation method,70 patients with kidney calculi were divided into mPCNL group (38 patients) and percutaneous nephrostolithotomy (PCNL) group (32 patients).The curative effect,serum creatinine (SCr) and blood urea nitrogen (BUN) postoperative 1 month were compared.Results The patients in two groups were successfully for broken calculi.The operation time of stag-horn calculi,retinitis simplex kidney pelvis calculi and kidney calices multiple calculi in PCNL group were significantly shorter than those in mPCNL group [(89.13 ± 13.36) min vs.(112.32 ± 12.41) min,(65.28 ±9.76) min vs.(78.84 ± 12.03) min,(98.97 ± 11.84) min vs.(112.64 ± 10.87) min,P ＜ 0.05].The first stage clearance rate of retinitis simplex kidney pelvis calculi in PCNL group was significantly higher than that in mPCNL group [88.89％(8/9) vs.57.14％(8/14),P ＜ 0.05].But the clearance rate of kidney calices multiple calculi in PCNL group was significantly lower than that in mPCNL group [58.33％(7/12) vs.86.67％(13/15),P＜0.05].The first stage clearance rate of stag-horn calculi in two groups had no significant difference [63.64％(7/11) vs.66.67％ (6/9),P ＞ 0.05].The patients in two groups had no serious complication.The rate of fever after operation in two groups had no significant difference [15.63％ (5/32) vs.10.53％ (4/38),P ＞ 0.05].The level of SCr and BUN in the patients combined with kidney insufficiency in two groups were decreased slightly (P ＞ 0.05).The improvement rate of renal function in two groups had no significant difference (P ＞0.05).Conclusions mPCNL and standard channel PCNL in treatment of kidney calculi can achieve a good first stage clearance rate,and the incidence rate of postoperative complication is lower.mPCNL and standard channel PCNL have no obviously influence on early stage renal function.The operation time of mPCNL is generally longer,but the therapeutic effect of kidney calices multiple calculi is better than standard channel PCNL.
