古军

[摘要] 目的 探討经皮肾镜取石术与输尿管镜下钬激光碎石术治疗直径≤3 cm肾结石的临床效果。方法 方便选取海南医学院第二附属医院泌尿外科2014年2月—2017年2月收治的90例直径≤3 cm肾结石患者为研究对象，以随机数字表法分为A组45例，B组45例，A组行输尿管镜下钬激光碎石术治疗，B组行经皮肾镜取石术治疗，观察两组手术情况、结石清除与复发情况及并发症发生率。结果 术中出血量测定显示，A组为（25.46±4.82）mL，B组为（49.13±5.75）mL，A组明显较少；手术时间A组为（90.25±6.13）min，B组为（110.37±7.40）min，术后住院时间A组为（4.92±1.04）d，B组为（6.84±1.58）d，A组明显较短，差异有统计学意义（P<0.05）；一期结石清除率A组为95.56%，同B组93.33%对比，差异无统计学意义（P>0.05），复发率A组为2.22%，同B组4.44%对比，差异无统计学意义（P>0.05）；术后并发症发生率A组为4.44%，同B组17.78%比较，明显较低，差异有统计学意义（P<0.05）。结论 在直径≤3 cm肾结石治疗中，输尿管镜下钬激光碎石术与经皮肾镜取石术均具有确切疗效，但前者手术创伤小、术后恢复快，且并发症发生率低，更值得推广。

[关键词] 肾结石；输尿管镜下钬激光碎石；经皮肾镜取石

[中图分类号] R629 [文献标识码] A [文章编号] 1674-0742（2018）02（b）-0083-03

[Abstract] Objective This paper tries to investigate the clinical effects of percutaneous nephrolithotomy and holmium laser lithotripsy under ureteroscope in treatment of renal calculi in less than 3cm in diameter. Methods 90 cases of patients with renal calculi with diameter less than 3 cm and who accepted treatments in the Second Affiliated Hospital of Hainan Medical University of Department of Urology from February 2014 to February 2017 were convenient selected as the research object， and were divided into the A group of 45 cases and the B group of 45 cases by random number table method. The group A were underwent ureteroscopic holmium laser lithotripsy， while the group B were underwent percutaneous nephrolithotomy. Then， the operation condition， stone clearance and recurrence and complication rate were observed between two groups. Results The amount of bleeding during operation was（25.46±4.82）mL in group A and （49.13±5.75）mL in group B， but less in group A（90.25 ± 6.13）min in group A and （110.37±7.40）min. The postoperative hospital stay was （4.92±1.04） days in group A and （6.84 ± 1.58） days in group B， and the difference was statistically significant（P<0.05）. The primary stone clearance rate in the group A was 95.56%， compared with the group B of 93.33%， and the difference was not statistically significant （P>0.05）. The recurrence rate in group A was 2.22%， compared with 4.44% in group B， and the difference was not statistically significant （P>0.05）. The incidence of postoperative complications in group A was 4.44%， which was significantly lower than that in B group （17.78%）， and the difference was statistically significant （P<0.05）. Conclusion Ureteroscopic holmium laser lithotripsy and percutaneous nephrolithotomy have the exact effect in the treatment of nephrolithiasis ≤3cm in diameter， but the former has the advantages of small operation trauma， rapid postoperative recovery and low complication rate， which is more worthy of promotion.

[Key words] Renal calculi； Ureteroscopic holmium laser lithotripsy； Percutaneous nephrolithotomy

肾结石是临床常见泌尿系统疾病，可引发腰部疼痛、尿路感染、血尿等，对患者正常工作、生活及健康有较大影响。对于保守治疗无确切效果肾结石患者，应考虑外科手术治疗，目前应用于临床术式较多，术式选择不仅要考虑结石清除效果，还应兼顾安全性[1]。对于直径≤3 cm肾结石，经皮肾镜取石术与输尿管镜下钬激光碎石术是常用术式，该研究通过对2014年2月—2017年2月该院收治的90例肾结石患者进行对比，探讨了两者的临床应用价值，现报道如下。

1 资料与方法

1.1 一般资料

方便选择该院收治的90例肾结石患者为研究对象，研究经伦理委员会审查并批准，以随机数字表法分组。观……