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目的探讨多通道经皮肾镜(PCNL)与单通道标准PCNL联合输尿管软镜(FURSL)治疗复杂性肾结石比较。方法回顾性分析2011年1月至2015年12月收治的93例复杂性肾结石的临床资料及治疗方法。其中A组为多通道PCNL组(33例);B组为单标准通道PCNL联合顺行或者逆行FURSL组(60例)。比较两组患者的年龄、结石大小、手术时间、术后血红蛋白下降值、术后住院天数、清石率和并发症等。结果 A组与B组年龄分别为(48.36±13.15)vs.(49.23±13.34)岁,结石直径分别为(3.65±0.47)vs.(3.55±0.39)cm,术后住院天数分别为(7.64±1.67)vs.(8.2±2.46)d、术后总结石清除率(81.8%)vs.(93.3%),并发症分别为(9.09%)vs.(6.67%),其间比较无统计学差异。A组与B组手术时间分别为(106.94±25.08)vs.(130.73±33.84)min,术后血红蛋白下降值分别为(14.33±7.14)vs.(10.90±4.79)g/L,期间比较有统计学差异。结论对于复杂性肾结石,多通道PCNL仍是一种可供选择的一线治疗方案。然而单标准通道PCNL联合FURSL,在减少手术出血上有优势。医生应根据其医疗设备、手术技能和患者的特点,为患者制定最优方案。
Objective To investigate the comparison between multi-channel percutaneous nephrolithotomy (PCNL) and single-channel standard PCNL combined with ureteral soft-mirror (FURSL) in the treatment of complex renal calculi. Methods Retrospective analysis of clinical data and treatment of 93 cases of complicated kidney stones admitted from January 2011 to December 2015 were retrospectively analyzed. Among them, group A was multichannel PCNL group (33 cases), group B was single standard PCNL group (60 cases) and cisplatin group (retrograde FURSL group). The age, stone size, operation time, postoperative hemoglobin decline, postoperative hospital stay, clear stone rate and complications were compared between the two groups. Results The age of group A and group B were (48.36 ± 13.15) vs. (49.23 ± 13.34) years respectively, the diameters of stones were (3.65 ± 0.47) vs. (3.55 ± 0.39) cm, and the postoperative hospital days were (7.64 ± 1.67) vs. (8.2 ± 2.46) d respectively. The total stone removal rate (81.8%) vs. (93.3%) and postoperative complications were (9.09%) vs. (6.67%) respectively. There was no significant difference between the two groups. The operative time in group A and group B was (106.94 ± 25.08) vs. (130.73 ± 33.84) min, and the postoperative hemoglobin decrease was (14.33 ± 7.14) vs. (10.90 ± 4.79) g / L, respectively Differences Conclusions Multi-channel PCNL is still an alternative first-line treatment for complex renal calculi. However, the single standard channel PCNL combined with FURSL has the advantage of reducing surgical bleeding. Doctors should make optimal plans for patients based on their medical equipment, surgical skills, and patient characteristics.