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目的:对比研究微创经皮肾取石术(MPCNL)和体外冲击波碎石术(ESWL)单一治疗婴幼儿肾结石的临床疗效。方法:46例婴幼儿肾结石采取手术治疗,其中MPCNL治疗24例,ESWL治疗22例。两组平均年龄分别为(22.62±8.69)个月和(23.50±6.64)个月,结石大小(21.44±3.50)mm和(21.73±1.70)mm。结果:MPCNL组24例中1例为双肾结石,平均手术时间(76.20±23.42)min,平均住院时间(14.13±5.80)d,一期清除率84%(21/25),二期MPCNL术后3个月复查,总结石清除率为96%(24/25),术后发热4例(16%),术后血红蛋白降低值(8.54±4.40)g/L,无一例输血。ESWL组22例肾结石1次治愈率31.82%(7/22),11例(50%)行2次碎石,3个月复查结石清除率为86.3%(19/22),10例(45.5%)出现发热、严重血尿、石街、腰痛、无尿等并发症,平均住院时间(6.64±2.28)d。经统计学处理,MPCNL组并发症及重复治疗率均较ESWL组低(P<0.05),结石清除率高(P<0.05),但平均手术时间和住院时间长(P<0.05)。MPCNL组患者术后血清肌酐和肾小球率过滤均改善(P<0.05),而ESWL组保持稳定(P>0.05)。结论:相比ESWL,MPCNL治疗小于3岁婴幼儿20mm以上肾结石结石清除率高,重复治疗率低,并发症少的优点,应作为手术经验丰富的术者首选治疗方式之一。
OBJECTIVE: To compare the clinical efficacy of monotherapy with minimally invasive percutaneous nephrolithotomy (MPCNL) and extracorporeal shock wave lithotripsy (ESWL) in the treatment of infant kidney stones. Methods: 46 cases of infant kidney stones were treated by surgery, of which 24 cases were treated with MPCNL and 22 cases were treated with ESWL. The average age of the two groups were (22.62 ± 8.69) months and (23.50 ± 6.64) months respectively, and the stone size was (21.44 ± 3.50) mm and (21.73 ± 1.70) mm respectively. Results: One case (24 nephrolithiasis) in MPCNL group had an average operation time (76.20 ± 23.42) min, an average length of hospital stay (14.13 ± 5.80) d and a 84% (21/25) Three months later, the total stone clearance rate was 96% (24/25), postoperative fever in 4 cases (16%) and postoperative hemoglobin decrease (8.54 ± 4.40) g / L, with no blood transfusion. The primary cure rate of 22 cases of ESWL nephrolithiasis was 31.82% (7/22) in 11 cases (50%), the stone clearance rate was 86.3% (19/22) in 3 months and 10 cases (45.5% %) Had fever, severe hematuria, stone street, back pain, no urine and other complications, the average length of stay (6.64 ± 2.28) d. After statistical analysis, the complications and repeated treatment rates in MPCNL group were lower than those in ESWL group (P <0.05). The stone clearance rate was high (P <0.05), but the average operation time and hospitalization time were longer (P <0.05). The postoperative serum creatinine and glomerular filtration rate in MPCNL group were improved (P <0.05), while those in ESWL group were stable (P> 0.05). Conclusion: Compared with ESWL and MPCNL, MPCNL has the advantages of high clearing rate of stone with more than 20mm in kidney and stones, lower repetition rate and fewer complications, and should be used as one of the first choice of surgical treatment for experienced surgeons.