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目的了解肋上通道与肋下通道经皮肾镜取石术治疗鹿角形肾结石的不同效果,寻找合适手术入路。方法 110例鹿角形肾结石患者随机分成观察一组和观察二组,各55例。两组都行经皮肾镜取石术,观察一组经肋上通道进行,观察二组经肋下通道进行。对比两组手术时间、术中出血量、结石清除效果、并发症、住院时间及复发率。结果观察一组手术时间为(72.38±21.96)min,观察二组为(98.66±24.09)min,两组对比差异具有统计学意义(P<0.01);观察一组术中出血量为(287.82±42.61)ml,观察二组为(329.53±39.55)ml,两组对比差异具有统计学意义(P<0.01);观察一组Ⅰ期结石清除率为72.73%、最终结石清除率为94.55%,观察二组Ⅰ期结石清除率为54.55%、最终结石清除率为78.18%,两组对比差异具有统计学意义(P<0.05);观察一组并发症发生率为1.81%,观察二组为12.73%,两组对比差异具有统计学意义(P<0.05);观察一组住院时间为(6.88±1.05)d,观察二组为(8.13±1.12)d,两组对比差异具有统计学意义(P<0.01);观察一组复发率为10.91%,观察二组为14.55%,两组对比差异无统计学意义(P>0.05)。结论无论是肋上通道还是肋下通道经皮肾镜取石术治疗鹿角形肾结石都可取得较满意的临床疗效,但相对肋下通道而言,肋上通道经皮肾镜取石术具有手术时间短、出血少、结石清除率高、并发症低、术后恢复快的优势。
Objective To understand the different effects of percutaneous nephrolithotomy on the antler-shaped kidney stones in the superior and inferior passages of the ribs and to find suitable surgical approaches. Methods One hundred and ten cases of antler kidney stones were randomly divided into observation group (n = 55) and observation group (n = 55). Percutaneous nephrolithotomy was performed in both groups, and one group was observed through the superior cervical canal. The second group was observed through the inferior rib cage. The operation time, intraoperative blood loss, stone removal, complications, length of hospital stay and relapse rate were compared between the two groups. Results The mean operative time was (72.38 ± 21.96) min in observation group and (98.66 ± 24.09) min in observation group. The difference between the two groups was statistically significant (P0.01). The intraoperative blood loss was (287.82 ± 42.61) ml, the observation group (329.53 ± 39.55) ml, the difference between the two groups was statistically significant (P <0.01); observed a group of stage Ⅰ stone clearance rate was 72.73%, the final stone clearance rate was 94.55% The stone clearance rate of Ⅰ group was 54.55%, the final stone clearance rate was 78.18%, the difference between the two groups was statistically significant (P <0.05). The incidence of complications was 1.81% in one group and 12.73% (P <0.05). The length of stay in one group was (6.88 ± 1.05) d and that in the second group was (8.13 ± 1.12) days, the difference between the two groups was statistically significant (P < 0.01). The relapse rate was 10.91% in one group and 14.55% in the second group. There was no significant difference between the two groups (P> 0.05). Conclusions Percutaneous nephrolithotomy lithospermatic lithotripsy can achieve satisfactory clinical results both in the superior and inferior channels. However, compared with the subtrochanteric channel, the percutaneous nephrolithotomy on the superior cervical canal has the advantages of operating time Short, less bleeding, high rate of stone clearance, low complication and quick postoperative recovery.