董阳阳+郭朝森+高俊东��

【摘要】目的比较微通道和小通道经皮肾镜取石术（PCNL）治疗复杂肾结石的疗效及安全性。

方法收集复杂肾结石患者112例，根据随机数字表将患者分为微通道（F14～F16）组和小通道（F18～F20）组，每组56例。微通道组采用微通道PCNL治疗，小通道组采用小通道PCNL治疗，比较两组临床疗效。

结果小通道组手术时间、术后感染率明显低于微通道组，一期结石清除率明显高于微通道组（P<0.05）。

结论经小通道PCNL治疗复杂肾结石能明显缩短手术时间，提高结石清除率，且不增加手术风险，值得临床推广应用。

【关键词】经皮肾镜取石术；微通道；小通道；复杂肾结石

中图分类号：R692.4文献标识码：ADOI：10.3969/j.issn.10031383.2017.02.017

【Abstract】ObjectiveTo compare efficacy and safety between micro channel and small channel percutaneous nephrolithotripsy （PCNL） in the treatment of complicated renal calculi.

Methods112 patients with complicated renal calculi were collected.They were divided into micro channel （F14～F16） group and small channel （F18～F20） group according to random number table method，with 56 cases in each group.Micro channel group were treated with micro channel PCNL，small channel group were treated with small channel PCNL，and then clinical efficacy between the two groups were compared.

ResultsOperation time of the small channel group was shorter，and postoperative infection rate was lower than that of the micro channel group，and primary stone clearance rate was significantly higher than that of the micro channel group（P<0.05）.

ConclusionSmall channel PCNL for complicated renal calculi can significantly shorten operation time，improve stone clearance rate，and it does not increase the risk of surgery.Thus，it is worthy of clinical application.

【Key words】PCNL；micro channel；small channel；complicated renal calculi

復杂肾结石包括鹿角形肾结石、孤立肾结石、多发性肾结石伴有肾盏颈狭窄和肾盏扩张，及并发肾脏解剖异常的结石，目前其临床治疗颇为棘手。随着微创技术更新完善，经皮肾镜碎石取石术（PCNL）已成为目前肾结石最常用的外科治疗手段，尤其是直径大于2 cm肾结石的首选。许多研究表明微通道（F14～F16）、小通道（F18～F20）PCNL治疗肾结石均能获得良好的效果[1～2]，但有关两种通道PCNL治疗复杂肾结石间的疗效及安全性的对比研究较为少见，为此笔者在2014年5月至2016年4月期间收集复杂肾结石患者112例，按随机对照方法分别采用微通道与小通道PCNL治疗，比较两种疗法的疗效及安全性，为复杂肾结石的治疗提供临床依据。

1对象与方法

1.1研究对象

本组112例复杂肾结石患者，术前均经超声、KUB、IVP、逆行肾盂输尿管造影等确诊。112例患者中，男68例，女44例；……