摘要目的 探讨微创经皮肾镜碎石取石术(mPCNL)治疗肾结石疗效及对肾功能的影响.方法 将70例肾结石患者按手术方式不同分为mPCNL组(38例)和经皮肾镜碎石取石术(PCNL)组(32例),观察两组治疗疗效及术前和术后1个月血肌酐和尿素氮的变化.结果 两组患者均成功完成一期碎石,PCNL组鹿角形结石、单纯性肾盂结石及肾盏多发性结石的手术时间均短于mPCNL组[(89.13±13.36) min比(112.32±12.41) min、(65.28±9.76) min比(78.84±12.03) min、(98.97±l1.84) min比(112.64± 10.87) min,P＜0.05]；PCNL组单纯性肾盂结石一期清除率高于mPCNL组[88.89％(8/9)比57.14％(8/14),P＜ 0.05],肾盏多发性结石一期清除率低于mPCNL组[58.33％(7/12)比86.67％(13/15),P＜0.05],两组鹿角形结石一期清除率比较差异无统计学意义[63.64％(7/11)比66.67％(6/9),P＞0.05].两组患者均未发生严重并发症,PCNL组和mPCNL组术后发热发生率比较差异无统计学意义[15.63％(5/32)比10.53％(4/38),P＞ 0.05].两组肾结石合并肾功能不全患者术后血肌酐、尿素氮较术前稍有下降,但术前与术后比较差异无统计学意义(P＞0.05)；两组术后肾功能改善率比较差异无统计学意义(P＞0.05).结论 mPCNL及PCNL治疗肾结石均能达到较好的一期结石清除率,术后并发症发生率低,对术后早期肾功能无明显影响,mPCNL较PCNL手术时间普遍延长,但对肾盏多发性结石治疗效果优于PCNL.

abstractsObjective To investigate the therapeutic effect of minimally invasive percutaneous nephrostolithotomy (mPCNL) in treatment of kidney calculi and the influence of renal function.Methods According to the operation method,70 patients with kidney calculi were divided into mPCNL group (38 patients) and percutaneous nephrostolithotomy (PCNL) group (32 patients).The curative effect,serum creatinine (SCr) and blood urea nitrogen (BUN) postoperative 1 month were compared.Results The patients in two groups were successfully for broken calculi.The operation time of stag-horn calculi,retinitis simplex kidney pelvis calculi and kidney calices multiple calculi in PCNL group were significantly shorter than those in mPCNL group [(89.13 ± 13.36) min vs.(112.32 ± 12.41) min,(65.28 ±9.76) min vs.(78.84 ± 12.03) min,(98.97 ± 11.84) min vs.(112.64 ± 10.87) min,P ＜ 0.05].The first stage clearance rate of retinitis simplex kidney pelvis calculi in PCNL group was significantly higher than that in mPCNL group [88.89％(8/9) vs.57.14％(8/14),P ＜ 0.05].But the clearance rate of kidney calices multiple calculi in PCNL group was significantly lower than that in mPCNL group [58.33％(7/12) vs.86.67％(13/15),P＜0.05].The first stage clearance rate of stag-horn calculi in two groups had no significant difference [63.64％(7/11) vs.66.67％ (6/9),P ＞ 0.05].The patients in two groups had no serious complication.The rate of fever after operation in two groups had no significant difference [15.63％ (5/32) vs.10.53％ (4/38),P ＞ 0.05].The level of SCr and BUN in the patients combined with kidney insufficiency in two groups were decreased slightly (P ＞ 0.05).The improvement rate of renal function in two groups had no significant difference (P ＞0.05).Conclusions mPCNL and standard channel PCNL in treatment of kidney calculi can achieve a good first stage clearance rate,and the incidence rate of postoperative complication is lower.mPCNL and standard channel PCNL have no obviously influence on early stage renal function.The operation time of mPCNL is generally longer,but the therapeutic effect of kidney calices multiple calculi is better than standard channel PCNL.