[1]朱　峰,陈帅奇,侯国栋,等.Ⅰ期肾穿刺造瘘后Ⅱ期经皮肾镜碎石术联合输尿管软镜碎石术治疗复杂性肾结石疗效观察[J].新乡医学院学报,2019,36(8):777-780.[doi:10.7683/xxyxyxb.2019.08.018]
　ZHU Feng,CHEN Shuai-qi,HOU Guo-dong,et al.Efficacy of percutaneous nephrostomy in stage Ⅰ and flexible ureteroscopic lithotripsy combined with percutaneous nephrolithotomy in stage Ⅱ for the treatment of complex renal calculus[J].Journal of Xinxiang Medical University,2019,36(8):777-780.[doi:10.7683/xxyxyxb.2019.08.018]
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Ⅰ期肾穿刺造瘘后Ⅱ期经皮肾镜碎石术联合输尿管软镜碎石术治疗复杂性肾结石疗效观察
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年8
页码:
777-780
栏目:
临床研究
出版日期:
2019-08-05

文章信息/Info

Title:
Efficacy of percutaneous nephrostomy in stage Ⅰ and flexible ureteroscopic lithotripsy combined with percutaneous nephrolithotomy in stage Ⅱ for the treatment of complex renal calculus
作者:
朱　峰; 陈帅奇; 侯国栋; 范毛川; 张新君; 张会清
(新乡医学院第一附属医院泌尿外科，河南　卫辉　453100)
Author(s):
ZHU Feng; CHEN Shuai-qi; HOU Guo-dong; FAN Mao-chuan; ZHANG Xin-jun; ZHANG Hui-qing
(Department of Urology，the First Affiliated Hospital of Xinxiang Medical University，Weihui 453100，Henan Province,China)
关键词:
复杂性肾结石; 肾造瘘; 经皮肾镜碎石术; 输尿管软镜碎石术
Keywords:
complex renal calculus; nephrostomy; percutaneous nephrolithotomy; flexible ureteroscopic lithotripsy
分类号:
R692.4
DOI:
10.7683/xxyxyxb.2019.08.018
文献标志码:
A
摘要:
目的　探讨Ⅰ期肾穿刺造瘘、Ⅱ期经皮肾镜碎石术（PCNL）联合输尿管软镜碎石术（FURL）治疗复杂性肾结石的疗效及其安全性。方法　选择2016年10月至2018年7月新乡医学院第一附属医院收治的复杂性肾结石患者57例为研究对象，其中行Ⅰ期肾穿刺造瘘、Ⅱ期PCNL联合FURL治疗26例（观察组），行标准通道PCNL治疗31例（对照组），比较2组患者手术时间、术中出血量、Ⅰ期结石清除率、术后留置肾造瘘管时间、术后住院时间、并发症发生情况。结果　观察组26例患者全部顺利完成手术，对照组1例因术中严重出血而行二次PCNL治疗。观察组患者手术时间、术中出血量、术后留置肾造瘘管时间均短于对照组，Ⅰ期结石清除率高于对照组（P<0.05），2组患者住院时间比较差异无统计学意义（P>0.05）。对照组和观察组患者术后并发症发生率分别为16.1%（5/31）和0.0%（0/26）；观察组患者术后并发症发生率低于对照组（χ2=4.258，P<0.05）。所有患者术后随访3个月，观察组患者1例术后4周行体外冲击波碎石（ESWL） 1次，1例行二次FURL治疗，术后3个月结石均顺利排出（100.0%）；对照组患者术后二次行PCNL 2例，FURL 5例，行ESWL 2例，3个月结石清除率为93.5%（29/31）;2组患者3个月结石清除率比较差异无统计学意义（χ2=1.738，P>0.05）。结论　Ⅰ期肾穿刺造瘘可明显减少Ⅱ期手术风险，而Ⅱ期双镜联合手术可明显提高结石清石率，相对于传统PCNL手术具有更好的疗效及安全性。
Abstract:
Objective　To investigate the efficacy and safety of percutaneous nephrostomy in stage Ⅰ and flexible ureteroscopic lithotripsy（FURL） combined with percutaneous nephrolithotomy（PCNL） in stage Ⅱ for the treatment of complex renal calculus.Methods　Fifty-seven patients with complex renal calculus admitted to the First Affiliated Hospital of Xinxiang Medical University from October 2016 to July 2018 were selected as the study subjects.Twenty-six patients (observation group) were treated with percutaneous nephrostomy in stage Ⅰ and PCNL combined with FURL in stage Ⅱ;thirty-one patients (control group) were treated with standard PCNL.The operation time,intraoperative bleeding volume,phase Ⅰ stone clearance rate,time of retaining renal fistula after operation,hospital stay after operation and complications were compared between the two groups.Results　All 26 patients in the observation group successfully completed the operation,while one patient in the control group underwent secondary PCNL due to severe bleeding.The operation time,intraoperative bleeding volume and the time of retaining renal fistula tube after operation in the observation group were shorter than those in the control group,and the stone clearance rate in stage Ⅰ was higher than that in the control group (P<0.05).There was no significant difference in the hospitalization time between the two groups (P>0.05).The incidence of postoperative complications in the control group and the observation group was 16.1% (5/31) and 0.0% (0/26),respectively.The incidence of postoperative complications in the observation group was lower than that in the control group (χ2=4.258,P<0.05).All patients were followed up for three months.One patients in the observation group underwent extracorporeal shock wave lithotripsy (ESWL) at four weeks after operation,and one patient underwent secondary FURL.The stones were discharged smoothly at three months after operation,The stone clearance rate at three months after operation was 100.0%.Two patients in the control group underwent PCNL in the second stage,five patients underwent FURL,and two patients underwent ESWL in the third month.The stone clearance rate at three months after operation was 93.5% (29/31).There was no significant difference in the stone clearance rate at three months after operation（χ2=1.738，P>0.05）.Conclusion　Percutaneous nephrostomy in stage Ⅰ can significantly reduce the risk of stage Ⅱ operation,and PCNL combined with FURL in stage Ⅱ can significantly improve the stone clearance rate.Compared with traditional PCNL surgery,it has better efficacy and safety.

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更新日期/Last Update: 2019-08-05