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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。
OBJECTIVE: To compare the clinical efficacy and safety of ureteral calculi combined with holmium laser lithotripsy and minimally invasive percutaneous nephrolithotomy in the treatment of renal pelvis and ureter by ureteral rigid tunnel. Methods: The data of 132 patients with renal pelvis and stone treated by soft-hard ureteroscopic combined with holmium laser lithotripsy or minimally invasive percutaneous nephrolithotomy were retrospectively analyzed from March 2012 to December 2013. Among them, 73 The cases were treated with soft-hard ureteroscope combined with holmium laser lithotripsy through ureteral hard-pathway, and 59 cases were treated with minimally invasive percutaneous nephrolithotomy. The operation time, hemoglobin decrease, postoperative hospital stay, residual stone and complications And other indicators. Results: There was no significant difference between the two groups in terms of age, sex, course of disease, left and right side, degree of hydration and stone size. The patients underwent ureteral hard-soft-lens combined with holmium laser lithotripsy: 66 patients underwent surgery. The average duration of surgery was (40.3 ± 8.3) min and the mean hemoglobin level was (1.3 ± 5.7) g / L. The average postoperative hospital stay (2.2 ± 0.7) days, the residual rate of stones was 9.1% (6 residual stones), 2 patients had fever after operation, 1 patient had renal colic, no ureteral rupture, avulsion, pelvis tears and other serious complications, Ureteral reflux was not observed at 3 months postoperatively. In the minimally invasive percutaneous nephrolithotomy group, the operation was completed in 59 cases. The mean duration of operation was (74.6 ± 12.2) min, mean hemoglobin level was (20.4 ± 10.4) g / L, average postoperative hospital stay was (5.1 ± 0.7) Day, the stone residual rate was 5.1% (3 cases of residual stones), 2 cases of bleeding, no other complications. There was significant difference between the two groups in operation time, hemoglobin reduction and postoperative days of hospitalization (both P <0.01). In terms of the residual rate of stones (P = 0.387) and the complication rate (P = 0.742) No significant difference was found between the two groups. Conclusion: The ureteral calculi combined with holmium laser lithotripsy under ureteral hard-ware surgery has short operative time, less trauma, faster recovery, less serious complication, and has more advantages than minimally invasive percutaneous nephrolithotomy .