3种方法治疗复杂性肾结石的疗效比较

摘要

目的：比较经皮肾镜取石术（PCNL）、后腹腔镜肾切开取石术、小切口肾切开取石术治疗复杂性肾结石的效果。方法复杂性肾结石患者共296例，其中采用 PCNL 治疗133例（PCNL 组）、后腹腔镜肾切开取石术治疗36例（腹腔镜组）、小切口肾切开取石术治疗127例（小切口组），治疗后观察不良反应和并发症，比较手术时间、术中出血量及结石清除率。结果PCNL 组与小切口组手术时间、术中出血量、结石清除率比较，差异无统计学意义（P ＞0．05）。腹腔镜组手术时间明显长于其他两组（ P ＜0．05）、结石清除率也明显低于其他两组（ P ＜0．05），但术中出血量明显少于其他两组（P ＜0．05）。3组转开放手术率比较，差异无统计学意义（P ＞0．05）。结论PCNL 治疗复杂性肾结石优于其他两种方法，可作为首选；腹腔镜肾切开取石术、小切口肾切开取石术可替代或部分替代传统的开放手术。%Objective To compare the effects of percutaneous nephrolithotomy(PCNL),retroperitoneal laparoscopic nephrolithotomy and mini-incision nephrolithotomy on complex renal calculus.Methods Two hundred and ninety-six patients with complex renal calculus were enrolled in the study,including 133,36 and 127 cases treated with PCNL(PCNL group),retroperitoneal laparoscopic nephrolithotomy (laparoscopy group) and mini-incision nephrolithotomy(mini-incision group),respectively.An observation on the adverse reactions and complications was performed after treatment,and the operation duration,intraoperative blood loss and stone clearance rate were compared among three groups.Results There was no significant difference in the operation duration,intraoperative blood loss or stone clearance rate between PCNL group and mini -incision group (P >0.05).Laparoscopy group gained significantly longer operation duration,lower stone clearance rate and less intraoperative blood loss compared with the other two groups( P<0 .05).There was no significant difference in the incidence of open surgery among three groups(P >0.05).Conclusion PCNL is superior to the other two approaches to the management of complex renal calculi,and it can act as the first-line operative approach.Retroperitoneal laparoscopic nephrolithotomy and mini-incision nephrolithotomy can substitute the conventional open surgery totally or partially.