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目的探讨经皮肾穿刺取石术(MPCNL)和经皮肾手辅助小通道取石术二种手术方法的疗效及安全性。方法采用MPCNL治疗肾结石患者112例,同期采用手辅助小通道肾结石患者120例,并对二种方法的手术时间、结石清除率及并发症率进行比较分析。结果伴有中等以下肾积水的肾结石患者采用二种方法在手术时结石清除率方面的差异无统计学意义(P>0.05);伴有重度肾积水的肾结石患者采用二种方法,MPCNL组手术的时间长于手辅助经皮肾小通道(P>0.01);结石清除率方面差异无统计学意义(P>0.05);二种方法穿刺通道的损伤、出血差异无统计学意义(P>0.05);术后发热方面手辅助组经皮肾高于MPCNL组(P>0.01)。结论 MPCNL和手辅助小通道取石术均为治疗肾结石的有效方法,但MPCNL效率与肾积水有关,而采用手辅助经皮肾效率与肾积水程度无关。制作此肾通道的相关并发症两组差异无统计学意义,但随着手术时间的延长,损伤比较大,采用高压水流冲洗碎石,肾脏剥离面增大及碎石残片存留的手辅助经皮肾相关并发症增多。
Objective To investigate the efficacy and safety of percutaneous nephrolithotomy (MPCNL) and percutaneous nephrolithotomy-assisted small-channel lithotomy. Methods One hundred and twelve patients with renal calculi were treated with MPCNL and 120 patients with hand-assisted small-channel renal calculi during the same period. The operative time, the rate of stone removal and the complication rate of the two methods were compared. Results There was no significant difference in the stone clearance rate between the two methods (P> 0.05). Nephrolithiasis patients with severe hydronephrosis were treated with two methods, The time of operation in MPCNL group was longer than that of hand-assisted percutaneous renal access (P> 0.01). There was no significant difference in the stone clearance between the two groups (P> 0.05). There was no significant difference between the two methods > 0.05). In terms of postoperative fever, the percutaneous renal involvement in the hand-assisted group was higher than that in the MPCNL group (P> 0.01). Conclusion Both MPCNL and hand-assisted small-channel lithotripsy are effective methods for the treatment of kidney stones. However, the efficiency of MPCNL is related to hydronephrosis. However, the effect of hand-assisted percutaneous nephrectomy is not related to the degree of hydronephrosis. There were no significant differences between the two groups in the complication of making this renal channel. However, with the prolongation of operation time, the injury was relatively large. High pressure water was used to wash the gravel, the exfoliated surface of the kidneys was enlarged, Kidney-related complications increased.