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目的探讨直径≤1.5 cm的肾盂结石最佳微创治疗方法。方法直径≤1.5 cm肾盂结石90例,其中47例行逆行途径的肾内手术(RIRS),采用输尿管硬镜联合软镜钬激光碎石,43例采用经皮肾镜碎石术(PCNL)。比较分析两种方法治疗结石的手术时间、碎石成功率、术后住院时间和并发症。结果 RIRS组和PCNL组结石平均直径分别为1.2 cm(1.0~1.5 cm)及1.3 cm(1.0~1.5 cm)。RIRS组手术均顺利完成,其中32例手术过程中换用输尿管软镜击碎冲入肾盏的结石。平均手术时间44 min(25~70 min),一期结石清除率达95.74%(45/47),术后发热2例,血红蛋白和红细胞压积轻度下降,血红蛋白平均下降(0.18±0.06)g/L,红细胞压积平均下降0.11%。所有患者均未发生并发症。PCNL组手术均顺利完成,平均手术时间70 min(45~90 min),一期结石清除率达95.35%(41/43),术后发热2例,血红蛋白平均下降(17.25±6.70)g/L,红细胞压积平均下降5.62%。PCNL2例出现明显术中、术后出血。结论对于直径≤1.5 cm的肾盂结石,RIRS组具有良好的清石率,其经自然腔道内镜手术的特点使其创伤小,主要并发症发生率明显低于PCNL,手术时间及住院时间均具有明显优势。对于直径≤1.5 cm的肾盂结石,应首选RIRS手术。
Objective To investigate the best minimally invasive treatment of renal pelvis with diameter ≤1.5 cm. Methods Ninety patients (diameter ≤1.5 cm) with renal pelvis and stones were involved. Forty-seven patients underwent retrograde nephrectomy (RIRS), ureteroscopic combined with holmium laser lithotripsy and 43 patients underwent percutaneous nephrolithotomy (PCNL). The operation time, the success rate of lithotripsy, postoperative hospital stay and complications of the two methods were compared and analyzed. Results The mean diameters of stones in RIRS group and PCNL group were 1.2 cm (1.0-1.5 cm) and 1.3 cm (1.0-1.5 cm), respectively. RIRS surgery were successfully completed, of which 32 cases of surgery for the replacement of ureteral soft lens crushed calculus of the calyx. The average operation time was 44 min (25-70 min). The rate of primary stone removal was 95.74% (45/47). The incidence of postoperative fever was 2, hemoglobin and hematocrit decreased slightly, hemoglobin decreased by 0.18 ± 0.06 g / L, hematocrit decreased by an average of 0.11%. No complications occurred in all patients. The average operation time was 70 min (45-90 min), 95.35% (41/43) in stage I, 2 cases postoperative fever and 17.25 ± 6.70 g / L average hemoglobin in PCNL group , Hematocrit decreased by an average of 5.62%. 2 cases of PCNL obvious intraoperative and postoperative bleeding. Conclusions For renal pelvis with diameter ≤1.5 cm, the RIRS group has a good rate of clear stone. The traumatic experience of natural laparoscopic surgery is less traumatic and the main complication rate is lower than that of PCNL. The operation time and hospital stay time Has obvious advantages. For renal pelvis ≤1.5 cm in diameter, RIRS surgery is preferred.