标题：三种微创手术方式治疗肾结石的临床疗效观察

      作者：管德佳，陈立波，王杰，刘思平    梅州市人民医院泌尿外一科，广东 梅州 514000

      卷次： 2021年32卷4期

      【摘要】 目的 比较经皮肾钬激光碎石、气压弹道碎石和超声联合弹道碎石治疗肾结石的临床疗效。方法 选择 2019年 1月至 2020年 7月梅州市人民医院泌尿外一科收治的 69例肾结石患者为研究对象，按随机数表法分为A组、B组和 C组，每组 23例，所有患者均接受经皮肾镜碎石术(PCNL)治疗，A组术中使用经皮肾钬激光碎石，B组使用气压弹道碎石，C组使用超声联合弹道碎石。比较三组患者的围术期情况、I期碎石率及术后并发症。结果 三组患者术中出血量、住院时间、肾造瘘管留置时间比较差异均无统计学意义(P>0.05)；A组患者的碎石时间和手术时间分别为(99.84±12.91) min、(140.32±17.30) min，B组为(80.02±10.83) min、(119.10±16.82) min，C组为(67.99±8.71) min、(104.55±12.32) min，C组明显短于A组和B组，B组明显短于A组，差异均有统计学意义(P<0.05)；A组、B组和C组患者 I期结石清除率分别为86.96%、78.26%、86.96%，差异无统计学意义(P>0.05)；A组、B组和C组患者术后并发症总发生率分别为17.39%、13.04%、8.70%，差异无统计学意义(P>0.05)。结论 经皮肾钬激光碎石、气压弹道碎石和超声联合弹道碎石治疗肾结石的疗效相似，均有较高的结石清除率，但超声联合弹道碎石的取石时间、手术时间明显更短。
      【关键词】 肾结石；经皮肾镜碎石术；经皮肾钬激光碎石；气压弹道碎石；超声；并发症
      【中图分类号】 R692.4 【文献标识码】 A 【文章编号】 1003—6350（2021）04—0472—04

Clinical efficacy of three minimally invasive surgical methods in the treatment of renal calculi.
GUAN De-jia,CHEN Li-bo, WANG Jie, LIU Si-ping. Department of Urology, Meizhou People's Hospital, Meizhou 514000, Guangdong,CHINA
【Abstract】 Objective To investigate the effect of percutaneous holmium laser lithotripsy, pneumatic ballisticlithotripsy and ultrasound combined with ballistic lithotripsy in the treatment of renal calculi, so as to provide referencefor clinical treatment. Methods A total of 69 patients with renal calculi, who admitted to Department of Urology, Mei-zhou People's Hospital from January 2019 to July 2020, were selected and divided into group A, group B and group C ac-cording to random number table method, with 23 patients in each group. All patients received percutaneous nephrolithot-omy (PCNL), percutaneous holmium laser lithotripsy was used in group A, pneumatic ballistic lithotripsy was used ingroup B, and ultrasound combined with ballistic lithotripsy was used in group C. The perioperative situation, lithotripsyrate and postoperative complications of the three groups were compared. Results There were no significant differencesin intraoperative blood loss, hospitalization time, and indwelling time of nephrostomy tube among the three groups (allP>0.05). The lithotripsy time and operation time in the group A, group B, and group C were (99.84±12.91) min and(140.32±17.30) min, (80.02±10.83) min and (119.10±16.82) min, (67.99±8.71) min and (104.55±12.32) min, respective-ly; those in the group C were significantly shorter than those in the group A and the group B, and those in the group Bwere significantly shorter than those in group A (all P<0.05). The stone clearance rates in group A, B, C were 86.96%,78.26%, and 86.96%, respectively, and there was no statistically significant differences (P>0.05). The total incidence ofcomplications in the group A, B, C were 17.39%, 13.04%, and 8.70%, respectively, and there was no statistically signifi-cant differences (P>0.05). Conclusion Percutaneous holmium laser lithotripsy, pneumatic ballistic lithotripsy and ultra-sound combined with ballistic lithotripsy have similar curative effects in the treatment of renal calculi, and all of themhave high stone clearance rate. But the stone extraction time and operation time of ultrasound combined with ballisticlithotripsy are significantly shorter.
      【Key words】 Renal calculi; Percutaneous nephrolithotomy (PCNL); Percutaneous holmium laser lithotripsy;Pneumatic ballistic lithotripsy; Ultrasound; Complications