龙赟 叶剑锋

【摘要】 目的：探讨B超引导下侧卧位单通道微创经皮肾镜取石术（MPCNL）治疗复杂性肾结石的效果。方法：选取2017年12月-2019年4月笔者所在医院收治的136例复杂性肾结石患者，依照手术方案不同将其分为试验组（68例）和对照组（68例）。对照组给予传统开放性手术治疗，试验组给予B超引导下侧卧位单通道MPCNL治疗。比较两组手术时间、排气时间、住院时间、下床活动时间、术中出血量、结石清除率、术后并发症发生率。结果：试验组结石清除率为92.65%（63/68），高于对照组的76.47%（52/68），差异有统计学意义（P<0.05）。试验组手术时间、排气时间、住院时间、下床活動时间、术中出血量少均优于对照组，差异有统计学意义（P<0.05）。试验组术后并发症发生率为5.88%（4/68），低于对照组的19.12%（13/68），差异有统计学意义（P<0.05）。结论：B超引导下侧卧位单通道MPCNL治疗复杂性肾结石效果显著，能清除结石，减少并发症发生风险，缩短康复进程。

【关键词】 复杂性肾结石 B超 侧卧位 单通道微创经皮肾镜取石术

[Abstract] Objective： To investigate the effect of single-channel minimally invasive percutaneous nephrolithotomy （MPCNL） in lateral position guided by B-ultrasound in the treatment of complicated kidney stones. Method： A total of 136 patients with complicated kidney stones admitted in our hospital from December 2017 to April 2019 were selected and divided into the experimental group （68 cases） and the control group （68 cases） according to different surgical procedures. The control group was treated with traditional open surgery， while the experimental group was treated with single-channel MPCNL in lateral position guided by B-ultrasound. The operation time， exhaust time， hospitalization time， time of getting out of bed， intraoperative blood loss， stone clearance rate， and postoperative complication rate were compared between the two groups. Result： The stone clearance rate of the experimental group was 92.65% （63/68）， which was higher than 76.47% （52/68） of the control group， the difference was statistically significant （P<0.05）. The operation time， exhaust time， hospitalization time， time of getting out of bed and the intraoperative blood loss of the experimental group were all better than those of the control group， the differences were statistically significant （P<0.05）. The incidence of postoperative complications in the experimental group was 5.88% （4/68）， which was lower than 19.12% （13/68） in the control group， the difference was statistically significant （P<0.05）. Conclusion： Single-channel MPCNL in lateral position guided by B-ultrasound has a significant effect on the treatment of complicated kidney stones， which can clear the stones， reduce the risk of complications and shorten the recovery process.

复杂性肾结石是泌尿外科常见疾病，发病率高，呈逐年增高趋势，且其病因复杂，处理棘手，易引起肾积水、尿路堵塞性疼痛，影响患者健康生活[1-3]。手术是临床治疗复杂性肾结石主要手段，传统多采用开放性手术治疗，但其对肾脏损伤较大，复发率较高，效果欠佳。近年来，随着超声技术不断发展，B超引导下微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotomy，MPCNL）在临床治疗肾结石方面得到广泛应用。本研究回顾性分析笔者所在医院收治的136例复杂性肾结石患者临床资料，对B超引导下侧卧位单通道MPCNL和传统开放手术治疗的效果进行比较，现报道如下。

1 资料与方法

1.1 一般资料

选取2017年12月-2019年4月笔者所在医院收治的136例复杂性肾结石患者，纳入标准：均经CT、静脉肾盂造影等检查确诊为复杂性肾结石，且为单肾结石;患者血尿常规等各项检查正常，具有手术指征;经美国麻醉医师学会（ASA）分级均为Ⅰ～Ⅱ级。……