CAJ | 학술논문

目的：：比较经输尿管硬通道下软硬镜联合钬激光碎石术与微创经皮肾镜取石术治疗肾盂结石的临床疗效及安全性.方法：回顾分析于2012年3月~2013年12月期间进行经输尿管硬通道下软硬镜联合钬激光碎石术或者微创经皮肾镜取石术治疗的132例肾盂结石患者资料,其中73例采用经输尿管硬通道下软硬镜联合钬激光碎石术,59例采用微创经皮肾镜取石术,比较两组手术时间、血红蛋白下降量、术后住院天数、结石残留率和并发症等指标.结果：两组患者在年龄、性别、病程、左右侧部位、积水程度、结石大小方面均无统计学差异.经输尿管硬通道下软硬镜联合钬激光碎石术组：66例完成手术,手术平均时间为(40.3±8.3)min,血红蛋白平均下降量为(1.3±5.7)g/L,术后平均住院(2.2±0.7)天,结石残留率为9.1％(6例残留结石),2例术后有发热,1例出现肾绞痛,无输尿管离断、撕脱、肾盂撕裂等严重并发症,术后3个月随访未发现输尿管反流.微创经皮肾镜取石术组：59例均完成手术,手术平均时间为(74.6±12.2)min,血红蛋白平均下降量为(20.4±10.4)g/L,术后平均住院(5.1±0.7)天,结石残留率为5.1％(3例残留结石),2例出现大出血,未见其他并发症.两组在手术时间、血红蛋白下降量、术后住院天数方面差异有统计学意义(均P＜0.01)；两组在结石残留率(P＝0.387)、并发症发生率(P＝0.742)方面,均差异无统计学意义.结论：经输尿管硬通道下软硬镜联合钬激光碎石术治疗肾盂结石的手术时间短,创伤小,康复快,并发症严重程度低,比微创经皮肾镜取石术具有更大的优势.
목적：：비교경수뇨관경통도하연경경연합화격광쇄석술여미창경피신경취석술치료신우결석적림상료효급안전성.방법：회고분석우2012년3월~2013년12월기간진행경수뇨관경통도하연경경연합화격광쇄석술혹자미창경피신경취석술치료적132례신우결석환자자료,기중73례채용경수뇨관경통도하연경경연합화격광쇄석술,59례채용미창경피신경취석술,비교량조수술시간、혈홍단백하강량、술후주원천수、결석잔류솔화병발증등지표.결과：량조환자재년령、성별、병정、좌우측부위、적수정도、결석대소방면균무통계학차이.경수뇨관경통도하연경경연합화격광쇄석술조：66례완성수술,수술평균시간위(40.3±8.3)min,혈홍단백평균하강량위(1.3±5.7)g/L,술후평균주원(2.2±0.7)천,결석잔류솔위9.1％(6례잔류결석),2례술후유발열,1례출현신교통,무수뇨관리단、시탈、신우시렬등엄중병발증,술후3개월수방미발현수뇨관반류.미창경피신경취석술조：59례균완성수술,수술평균시간위(74.6±12.2)min,혈홍단백평균하강량위(20.4±10.4)g/L,술후평균주원(5.1±0.7)천,결석잔류솔위5.1％(3례잔류결석),2례출현대출혈,미견기타병발증.량조재수술시간、혈홍단백하강량、술후주원천수방면차이유통계학의의(균P＜0.01)；량조재결석잔류솔(P＝0.387)、병발증발생솔(P＝0.742)방면,균차이무통계학의의.결론：경수뇨관경통도하연경경연합화격광쇄석술치료신우결석적수술시간단,창상소,강복쾌,병발증엄중정도저,비미창경피신경취석술구유경대적우세.
Objective:To compare the clinical efficacy and safety of rigid combined flexible ureteroscope homium laser lithotripsy with rigid ureteral access sheath and mini-percutaneous nephrolithotomy for pelvic calculi.Methods:Between March 2012 and December 2013,of the total 132 cases,seventy-three cases underwent rigid combined flexi-ble ureteroscope homium laser lithotripsy with rigid ureteral access sheath (group A),and 5 9 cases underwent mini-percutaneous nephrolithotomy (group B).The operating time,hemoglobin decreased value,postoperation hospital stay time,stone residue rate and complication were compared between the two groups.Results:There was no signifi-cant difference between the two groups in terms of age,gender,course of disease,position,degree of hydronephro-sis and stone size (P>0.05).66 cases of the total 73 cases in group A were completed successfully in the first proce-dure.The mean operating time was (40.3±8.3)min.The decreased mean hemoglobin value was (1.3±5.7)g/L. The mean post-operative hospital stay was (2.2±0.7)days.The stone residue rate was 9.1%.2 cases had fever af-ter operation.One case was suffered with renal colic.No case was suffered with ureteral transaction,avulsion,the renal pelvis tearing or other serious complications.No case was suffered with ureteral reflux after three months fol-lowing-up.All of the 59 cases in group B were completed successfully.The mean operating time was (74.6±12.2) min.The decreased mean hemoglobin value was (20.4±10.4)g/L.The mean post-operative hospital stay was (5.1 ±0.7)days.The stone residue rate was 5.1%.Except 2 cases were suffered with massive hemorrhage,no case was suffered with another serious complications.The operating time,the decreased hemoglobin value and the post-opera-tive hospital stay time had significant difference between the two groups (P<0.05).The stone residue rate and com-plication rate were not significantly different between the two groups (P>0.05).Conclusions:Of the two surgical technique,the rigid combined flexible ureteroscope homium laser lithotripsy with rigid ureteral access sheath has more advantages for the shorter operating time,less trauma,faster recovery,and lower severity of complications for pelvic calculi.