韦安强

[摘要] 目的 探讨经皮肾镜碎石术治疗肾结石的临床效果。方法 方便选取2015年3月—2016年9月来该院治疗的肾结石患者80例，随机分为实验组和对照组各40例。所有患者经尿培养试验、B超及CT检查，实验组采用B超下经皮肾镜气压弹道碎石术治疗，对照组采用开放性手术治疗，选择两组患者的结石清除率和术中出血量、尿外渗、术中损伤及平均住院时间作为观察指标来分析经皮肾镜碎石术的临床疗效。结果 实验组采用经皮肾镜碎石术治疗，结石清除率为97.5%；对照组采用开放性手术治疗，结石清除率为82.5%，差异有统计学意义（P=0.025 3 <0.05）。同时比较两组患者的术中出血量（P=0.030 1）、尿外渗（P=0.020 9）、术中损伤（P=0.047 9）及平均住院时间（P=0.028 7），差异有统计学意义（P<0.05）。结论 经皮肾镜碎石术在治疗复杂性难治性肾结石的过程中，结石清除率高，手术损伤小，住院时间短，值得临床推广应用。

[关键词] 经皮肾镜碎石术；肾结石；疗效；观察

[中图分类号] R692.4 [文献标识码] A [文章编号] 1674-0742（2018）06（b）-0056-03

Study on Curative Effect of Percutaneous Nephrolithotomy in Treatment of Renal Stones

WEI An-qiang

Department of Urinary Surgery， Mudan Peoples Hospital， Heze， Shandong Province， 274000 China

[Abstract] Objective To study the clinical effect of percutaneous nephrolithotomy in treatment of renal stones. Methods 80 cases of patients with renal stones treated in our hospital from March 2015 to September 2016 were convenient selected and randomly divided into two groups with 40 cases in each， all patients were for urine culture test， B ultrasound and CT examination， and the experimental group were treated with percutaneous nephrolithotomy with pneumatic lithotripsy under B ultrasound， and the control group were treated with open surgery， and the stone clearance rate， intraoperative bleeding amount， urinous infiltration， intraoperative injury and average length of stay of the two groups were observed， and the clinical curative effect was analyzed. Results The stone clearance rate in the experimental group and in the control group was respectively 97.5% and 82.5% and the difference was statistically significant（P=0.025 3<0.05）， at the same time， the intraoperative bleeding amount （P=0.030 1）， urinous infiltration （P=0.020 9） and intraoperative injury （P=0.047 9） and average length of stay （P=0.028 7） were compared between the two groups， all the differences were statistically significant（P<0.05）. Conclusion The stone clearance rate of percutaneous nephrolithotomy in treatment of renal stones is high with small operation injury and short length of stay， and it is worth clinical promotion and application.

[Key words]Percutaneous nephrolithotomy； Renal stone； Curative effect； Observation

腎结石是指发生在肾盂、肾盏的结石，是我国常见的泌尿系统疾病之一，男性患者较多，且具有复发性。结石的形状多种多样，肾结石中较为复杂的形状是鹿角形，仅发生在肾盂中。除了结构，结石的硬度也是临床治疗的影响因素，硬度最高的是草酸钙，其次是磷灰石，再次是尿酸、胱氨酸、磷酸氢钙[1]。根据结石的大小、位置、活动度的不同，肾盂、肾盏的结石除了会产生局部的机械性损害[2]、感染外，还会导致尿路梗阻和肾盏积水，随着梗阻时间的持久，肾积水情况恢复正常状态的可能性越低，直至肾功能丧失。临床上患者往往是因为出现血尿、疼痛等症状而进行检查确诊，肾绞痛发作时患者疼痛难以忍受，面容痛苦、坐立不安、恶心呕吐。经皮肾镜碎石术适用于结石直径偏大、多发性以及上述的鹿角形结石[3]。……