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目的探讨经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石的临床疗效。方法选取2014年10月~2015年10月复杂性肾结石40例,随机分为观察组和对照组,每组20例。观察组采用皮肾镜联合输尿管软镜钬激光碎石术,对照组采用经皮肾镜取石术,比较2组手术时间、术中出血量、住院时间、一期手术结石清除率、术后并发症发生率等情况。结果 40例手术均顺利完成。观察组手术时间明显短于对照组[(80.2±12.0)min vs.(104.4±9.7)min,t=-7.014,P=0.000],2组术中出血量[(109.6±7.1)ml vs.(112.7±5.6)ml,t=-1.533,P=0.134]和住院时间差异无显著性[(6.8±1.3)d vs.(7.0±1.1)d,t=-0.525,P=0.602]。观察组一期手术结石清除率明显高于对照组[85.0%(17/20)vs.50.0%(10/20),Fisher精确检验,P=0.020],并发症发生率明显低于对照组[10.0%(2/20)vs.45.0%(9/20),Fisher精确检验,P=0.015]。随访3个月,观察组2例二期行体外震波碎石术(extracorporeal shock wave lithotripsy,ESWL),对照组4例,2组比较无统计学差异(Fisher精确检验,P=0.331);对照组二期行经皮肾镜取石术3例,观察组无一例,2组比较无统计学差异(Fisher精确检验,P=0.115)。术后1、3个月复查,2组结石清除率无显著差异[90.0%(18/20)vs.75.0%(15/20),Fisher精确检验,P=0.204;95.0%(19/20)vs.90.0%(18/20),Fisher精确检验,P=0.500]。结论经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石疗效显著,具有结石清除率高、并发症少等优点,值得临床推广应用。
Objective To investigate the clinical efficacy of percutaneous nephrolithotomy combined with ureteroscopic holmium laser lithotripsy in the treatment of complex renal calculus. Methods Forty patients with complicated kidney stones from October 2014 to October 2015 were randomly divided into observation group and control group, with 20 cases in each group. The observation group was treated by combined nephrolithotomy and ureteroscopic holmium laser lithotripsy. The control group was treated by percutaneous nephrolithotomy. The operative time, intraoperative blood loss, hospitalization time, the rate of primary stone removal, postoperative complications The incidence of disease and so on. Results 40 cases were successfully completed. The operative time in the observation group was significantly shorter than that in the control group [(80.2 ± 12.0) min vs. (104.4 ± 9.7) min, t = -7.014, P = 0.000] (112.7 ± 5.6) ml, t = -1.533, P = 0.134]. There was no significant difference between the two groups in hospitalization time [(6.8 ± 1.3) d vs. (7.0 ± 1.1) days, t = -0.525, P = 0.602]. The rate of primary stone removal in the observation group was significantly higher than that in the control group [85.0% (17/20) vs. 50.0% (10/20), Fisher’s exact test, P = 0.020] 10.0% (2/20) vs. 45.0% (9/20), Fisher’s exact test, P = 0.015]. After 3 months of follow-up, extracorporeal shock waves lithotripsy (ESWL) was performed in 2 cases in the observation group. There were 4 cases in the control group. There was no significant difference between the two groups (Fisher exact test, P = 0.331) In the second stage, 3 cases were treated by percutaneous nephrolithotomy, and there was no one in the observation group. There was no significant difference between the two groups (Fisher’s exact test, P = 0.115). There were no significant differences in stone clearance between the two groups (90.0% (18/20) vs 75.0% (15/20), Fisher exact test, P = 0.204; 95.0%, 19/20) vs.90.0% (18/20), Fisher’s exact test, P = 0.500]. Conclusion Percutaneous nephrolithotomy combined with ureteroscopic ureteroscopic holmium laser lithotripsy for the treatment of complex nephrolithiasis has significant curative effect, which has the advantages of high stone clearance rate and few complications, which is worthy of clinical application.