取石器械配合微通道经皮肾镜取石治疗 复杂性上尿路结石的临床研究

Treatment of complex upper urinary tract calculi with lithotripsy instruments in mPCNL

摘要:

目的 探讨联合取石器械（套石网篮、封堵器及异物钳）在微通道经皮肾镜取石术治疗复杂性 上尿路结石中的临床价值。方法 选取2016 年3 月—2018 年1 月于徐州医科大学附属淮安医院微通道经皮 肾镜取石术治疗的69 例患者。其中，复杂性肾结石36 例，单发复杂性输尿管上段结石18 例，输尿管结石合 并多发肾结石15 例。将患者随机分为实验组和对照组。实验组采用微通道经皮肾镜取石术，术中联合3 种取 石器械，对照组采用微通道经皮肾镜取石术。对两组患者的临床资料进行比较分析。结果 实验组患者平均 取石时间、住院时间均较对照组缩短、术中出血量较对照组减少（P <0.05），实验组一期结石清除率较对照 组高（P <0.05）。两组术后并发症比较，差异无统计学意义（P >0.05）。结论 取石器械配合微通道经皮肾镜 取石术，可减少手术时间，彻底清除结石，技术安全，可作为处理复杂性结石的有效方案。

Abstract:

Objective To investigate the clinical application of lithotripsy instruments (ureteral occlude,ureteral stone basket and forceps) in microchannel percutaneous nephrolithotomy (mPCNL) to treat complex upper urinary tract calculi in surgery. Methods A total of 69 cases of the patients who had underwent mPCNL were retrospectively analyzed in our hospital from March 2016 to January 2018, including 36 cases of complex renal calculi, 18 cases of single complicated upper ureteral calculi and 15 cases of ureteral calculi with multiple renal calculi.They were randomly divided into two groups: 38 cases in the experimental group which had been intraoperatively used the three lithotripsy instruments in the mPCNL and 31 cases in the control group which had been used the mPCNL only. The averagelithotripsy time ,the blood loss during operation, the length of hospital stay and one-stage stonefree rate and postoperative complications were compared between the two groups. Results The average stone removal time, intraoperative hemorrhage and hospitalization time of the experimental group were lower than those of the control group (P < 0.05), and the stone removal rate of the experimental group was higher than that of the control group (P < 0.05). There was no significant difference in postoperative complications between the two groups (P > 0.05). Conclusions The use of ureteral occluder,ureteral stone basket and forceps lithotripsy in mPCNL can reduce the operation time, completely remove stones, and is technically safe. It can be used as an effective method to treat the complex stones.