唐文龙 彭志军 杨金涛 谢红兵

[摘要] 目的 探討肾结石患者应用输尿管软镜与经皮肾镜的临床治疗效果，并分析患者手术后的并发症发生情况。方法 方便选择该院2015年7月—2016年9月期间所收治的72例肾结石患者作为该次研究病例，按照随机数字表法将其分为A组和B组，每组各36例，A组应用输尿管软镜治疗，B组经皮肾镜治疗，对比分析两组患者的临床效果，手术中出血量以及清石率，并比较两组的不良反应发生情况。结果 结石直径在20 mm以上的患者中，A组手术中出血量与手术时间显著少于B组，组间差异有统计学意义;结石直径在20 mm以下的A组清石率为88.23%（15/17），B组为88.88%（16/18），组间差异无统计学意义（χ2=0.355 4，P=0.551 0），结石直径在20 mm以上的A组清石率为63.15%（12/19），B组为94.44%（17/18），组间差异有统计学意义（χ2=5.338 9，P=0.020 8）。A组手术后并发症发生率为11.11%，与B组比较（38.89%）差异有统计学意义（P<0.05）。结论 经皮肾镜手术最困难的就是穿刺，输尿管软镜则能够为患者提供良好的治疗通道。对于存在解剖结构异常或是凝血功能异常以及穿刺困难的患者来说，无论结石的大小都是输尿管的适应证。

[关键词] 肾结石;输尿管软镜术;经皮肾镜术;术后并发症

[中图分类号] R699.2          [文献标识码] A          [文章编号] 1674-0742（2018）09（a）-0026-03

Clinical Effect and Postoperative Complications of Ureteral Soft Tissue and Percutaneous Nephrolithotomy for Kidney Stones

TANG Wen-long， PENG Zhi-jun， YANG Jin-tao， XIE Hong-bing

Department of Urology， Lincang People's Hospital， Lincang， Yunnan Province， 677000 China

[Abstract] Objective To investigate the clinical effect of ureteral soft tissue and percutaneous nephrolithotomy in patients with kidney stones， and to analyze the postoperative complications. Methods A total of 72 patients with kidney stones who were treated in the hospital from July 2015 to September 2016 were convenient selected as the study case. According to the random number table method， they were divided into group A and group B， with 36 cases in each group. The group was treated with ureteroscopy， and group B was treated with percutaneous nephrolithotomy. The clinical effects， bleeding volume and stone rate of the two groups were compared， and the adverse reactions of the two groups were compared. Results In patients with a diameter of more than 20 mm， the amount of bleeding and operation time in group A were significantly less than those in group B. The difference between groups was statistically significant. The rate of clear stone in group A with stones below 20 mm was 88.23%（15/17）， group B was 88.88% （16/18）， the difference between groups was not statistically significant（χ2=0.355 4，P=0.551 0）， and the rate of clear stone in group A with stone diameter above 20 mm was 63.15% （12/19）， group B was 94.44% （17/18）， the difference between groups was statistically significant（χ2=5.338 9，P=0.020 8）. The incidence of postoperative complications in group A was 11.11%， and there was a statistically significant difference compared with group B （38.89%）， the difference was statistically significant（P<0.05）. Conclusion The most difficult part of percutaneous nephrolithotomy is puncture， and ureteroscopy can provide a good treatment channel for patients. For patients with abnormal anatomical structures or abnormal coagulation function and difficulty in puncture， regardless of the size of the stone， the ureter is an indication.

[Key words] Kidney stones; Ureteral soft tissue; Percutaneous nephrolithotomy; Postoperative complications

随着医学技术的不断发展，经皮肾镜与输尿管软镜治疗手术已经得到了广泛的应用与认可[1]，若患者肾结石直径在20 mm以下（包括20 mm），可以选择输尿管软镜手术治疗，若患者肾结石直径在20 mm以上，则可以应用经皮肾镜治疗，若患者存在肾功能不全或是穿刺困难，无论结石大小都属输尿管软镜的适应证范畴。该文为提高肾结石患者的生活质量，特此研究输尿管软镜与经皮肾镜术治疗的临床效果，研究对象为2015年7月—2016年9月收治的72例肾结石患者，具体报道如下。

1  资料与方法