目的：探讨微通道经皮肾镜钬激光碎石取石术（mPCNL）与标准通道经皮肾镜钬激光碎石取石术（标准通道PCNL）治疗肾结石的临床疗效。方法回顾性研究2012年10月至2014年10月，应用B超引导下mPCNL与标准通道PCNL分别治疗150例肾结石。比较两组患者的手术时间、Ⅰ期结石清除率、术中出血量、术中输血率、肾造瘘管留置时间，观察患者术后有无并发症（迟发型出血、感染等）。结果 mPCNL组与标准通道PCNL组一期分别建立F18和F24肾穿刺通道。标准通道PCNL组手术时间比mPCNL组缩短（P＜0.05）；单纯肾盂结石Ⅰ期清除率较mPCNL组要高（P＜0.05）；mPCNL组对多发性肾盏结石患者Ⅰ期结石清除率比标准通道PCNL组高（P＜0.05）。mPCNL组术中输血率、肾造瘘管留置时间以及术后并发症差异无统计学意义（P＞0.05），但术中出血量明显少于标准通道PCNL组（P＜0.05）。结论 MPCNL与标准通道PCNL均具有术中损伤小、Ⅰ期结石清除率高、并发症少等优点。标准通道PCNL适合较大的肾盂结石，而肾盏多发结石应首先考虑mPCNL，经皮肾镜钬激光碎石取石术处理肾结石安全、有效。%Objective To compare the efficacy and advantages of standard percutaneous nephrolithotomy(PCNL)and mini-percutaneous nephrolithotomy(mPCNL)in the treatment of renal calculi,improve the treatment of kidney stones.Methods From October 2012 to October 2014, application of B-guided PCNL was performed in 150 patients and mPCNL in 150 patients. Statistics the stone-free rate and effcts on renal function.Results 18F and 24F percutaneous renal access were successfully established in PCNL and mPCNL group respectively.The PCNL group had a shorter operation time than the mPCNL group. The one-stage stone-free rate for multiple stones was significantly higher in the mPCNL group than in the PCNL group. However, the rate for simple renal pelvis stone was significantly lower in the mPCNL group than in the PCNL group. There was no statistical difference in the one-stage stone-free rate for staghorn stone,complications rate, blood transfusion, and postoperative hospital stay between the two groups. The blood loss in mPCNL was less than in PCNL group, but the rate of blood transfusion and the remaining was no significant difference.Conclusion The PCNL may be suitable for large renal stone,while mPCNL may has advantages in the treatment for renal calyx stone.
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