标题：三种不同微创碎石方式治疗肾结石的疗效及安全性研究

      作者：李国，黄英，谢建湖，甘露，黄桂晓    深圳市罗湖区人民医院泌尿外科，广东 深圳 518001

      卷次： 2022年33卷14期

      【摘要】 目的 比较钬激光碎石、弹道碎石和超声联合弹道碎石三种方式治疗肾结石的疗效及安全性。方法 选择2018年2月至2021年2月在深圳市罗湖区人民医院泌尿外科院接受治疗的90例肾结石患者进行研究，按照随机数表法分为对照组、研究组和联合组各30例，分别采用弹道碎石术、钬激光碎石术和超声联合弹道碎石术治疗。比较三组患者碎石时间、手术时间、术中出血量、住院时间以及肾造瘘管留置时间，比较三组患者术前及术后的肾盂集合系统分离指数、肌酐、尿素氮指标以及术后并发症发生情况。结果 联合组患者的碎石时间、手术时间分别为(70.02±8.72) min、(105.02±12.19) min，明显短于研究组的(99.87±12.76) min、(139.61±17.62) min和对照组的(81.23±10.85) min、(120.83±15.97) min，研究组患者的碎石时间、手术时间明显短于对照组，差异均具有统计学意义(P<0.05)；联合组患者的肾盂集合系统分离指数、肌酐、尿素氮分别为(33.60±8.02) mm、(7.36±0.85) mmol/L、(187.72±36.01) mmol/L，明显低于研究组的(36.28±9.12) mm、(8.05±0.90) mmol/L、(195.37±39.79) mmol/L和对照组的(39.76±10.57) mm、(8.92±1.03) mmol/L、(192.39±38.63) mmol/L，研究组患者的肾盂集合系统分离指数、肌酐、尿素氮明显低于对照组，差异均具有统计学意义(P<0.05)；三组患者的并发症发生率比较差异无统计学意义(P>0.05)。结论 三种微创碎石术在治疗肾结石均具有一定的治疗效果，但超声联合弹道碎石可有效缩短手术时间，促进术后恢复，且不增加术后并发症。
      【关键词】 钬激光碎石；弹道碎石；超声联合弹道碎；肾结石；疗效
      【中图分类号】 R692.4 【文献标识码】 A 【文章编号】 1003—6350（2022）14—1821—04

Clinical efficacy and safety of three different minimally invasive lithotripsy methods in the treatment of renalcalculi.
LI Guo, HUANG Ying, XIE Jian-hu, GAN Lu, HUANG Gui-xiao. Department of Urinary Surgery, Shenzhen LuohuDistrict People's Hospital, Shenzhen 518001, Guangdong, CHINA
【Abstract】 Objective To study the clinical efficacy and safety of three different minimally invasive lithotripsymethods in the treatment of renal calculi. Methods Ninety patients with renal calculus who received treatment in De-partment of Urology, Shenzhen Luohu District People's Hospital from February 2018 to February 2021 were selected forthis study. They were divided into control group, study group, and combined group by random lottery, with 30 patients ineach group, which were treated with ballistic lithotripsy, holmium laser lithotripsy, and ultrasound combined ballistic lith-otripsy, respectively. The lithotripsy time, operation time, intraoperative bleeding, length of hospital stay, and retentiontime of nephrostomy were compared. The separation index of renal pelvis collection system, creatinine, urea nitrogen,and postoperative complications were compared before and after operation. Results After treatment, lithotripsy timeand operation time of the combined group were (70.02±8.72) min and (105.02±12.19) min, significantly lower than(99.87±12.76) min and (139.61±17.62) min of the study group and (81.23±10.85) min and (120.83±15.97) min of thecontrol group; the lithotripsy time and operation time in the study group were significantly shorter than those in the controlgroup; the differences were statistically significant (P<0.05). Separation index of collecting system of renal pelvis, creati-nine, and urea nitrogen in the combined group were (33.60±8.02) mm, (7.36±0.85) mmol/L, (187.72±36.01) mmol/L, re-spectively, which were significantly lower than (36.28±9.12) mm, (8.05±0.90) mmol/L, (195.37±39.79) mmol/L in thestudy group and (39.76±10.57) mm, (8.92±1.03) mmol/L, (192.39±38.63) mmol/L in the control group; the levels inthe study group were significantly lower than those in the control group; the differences were statistically significant(P<0.05). There was no significant difference in the incidence of complications among the three groups (P>0.05).Conclusion Three kinds of minimally invasive lithotripsy have certain therapeutic effects in the treatment of renal cal-culi, but ultrasound combined with ballistic lithotripsy can effectively shorten the operation time and promote postopera-tive recover.
      【Key words】 Holmium laser lithotripsy; Ballistic crushed stone; Ultrasound combined with ballistic lithotripsy;Renal calculus; Curative effect