超声碎石配合经皮肾镜气压弹道碎石术治疗肾结石的可行性

陈远祥　邹峰　华庆生

【摘要】 目的：探討超声碎石配合经皮肾镜气压弹道碎石术治疗肾结石的临床效果。方法：将2014年

1月-2016年12月在本院接受治疗的120例肾结石患者按照随机数字法均分为两组，60例患者采用经皮肾镜气压弹道碎石术治疗（对照组），60例给予超声碎石配合经皮肾镜气压弹道碎石术治疗（研究组）。比较两组患者术中出血量、手术时间、肛门排气时间、术后住院时间、结石清除情况、并发症情况以及SF-36量表评分。结果：研究组术中出血量显著少于对照组，手术时间、肛门排气时间以及术后住院时间均显著短于对照组，差异均有统计学意义（P<0.05）。研究组Ⅰ期结石清除率（80.00%）显著高于对照组（65.00%），Ⅱ期结石清除率（83.33%）显著高于对照组（61.90%），差异均有统计学意义（P<0.05）。研究组术后并发症发生率显著低于对于对照组（P<0.05）。干预前两组SF-36量表各维度评分比较，差异均无统计学意义（P>0.05），干预后两组SF-36量表各维度评分均显著升高，且研究组升高更显著（P<0.05）。结论：肾结石选择超声碎石配合经皮肾镜气压弹道碎石术治疗效果更好，对患者损伤较小，恢复速度快，并发症少，操作简单安全，值得在临床上推广使用。

【关键词】 肾结石； 经皮肾镜气压弹道碎石术； 超声碎石术

Feasibility of Ultrasonic Lithotripsy Combined with Pneumatic Lithotripsy in the Treatment of Renal Calculi/CHEN Yuan-xiang，ZOU Feng，HUA Qing-sheng.//Medical Innovation of China，2017，14（26）：112-115

【Abstract】 Objective：To investigate the clinical effect of ultrasonic lithotripsy combined with percutaneous pneumatic lithotripsy in the treatment of renal calculi.Method：120 patients with renal calculi treated in our hospital from January 2014 to December 2016 were divided into two groups according to random number method，60 patients were treated with percutaneous pneumatic lithotripsy（the control group），and 60 patients were treated with ultrasound lithotripsy combined with percutaneous nephrolithotomy（the study group）.The intraoperative bleeding volume， operation time， anal exhaust time， postoperative hospital stay，stone clearance，complications and SF-36 scale scores of two groups were compared.Result：The amount of intraoperative bleeding of the study group was significantly less than that in the control group，and the operation time，anal exhaust time and postoperative hospital stay were significantly shorter than those of the control group（P<0.05）.The stone clearance rate in the Ⅰ stage of the study group（80.00%） was significantly higher than that of the control group（50.00%），and the stone clearance rate in the Ⅱ stage（85.00%） was significantly higher than that of the control group（58.00%）（P<0.05）.The incidence of postoperative complications of the study group was significantly higher than that of the control group（P<0.05）.Before intervention，there were no significant differences between two groups in SF-36 scale score（P>0.05）.After intervention，the scores of each dimension of SF-36 scale between two groups were significantly increased，and the study group increased（P<0.05）.Conclusion：In the treatment of renal calculi，the choice of ultrasonic lithotripsy combined with percutaneous nephrolithotomy pneumatic lithotripsy is better，less damage to patients，faster recovery and less complications.The operation is simple and safe，and is worth of popularizing in clinic.endprint

【Key words】 Renal calculi； Percutaneous nephrolithotomy pneumatic lithotripsy； Ultrasonic lithotripsy

First-authors address：Shunde Hospital of Southern Medical University，Foshan 528300，China

doi：10.3969/j.issn.1674-4985.2017.26.029

肾结石是临床中常见的一种泌尿系统疾病，具有较高的发病率。患者体内一旦出现结石可能引起尿路梗阻，出现损伤，严重者可致肾功能衰竭。目前治疗肾结石的主要手段为超声碎石或经皮肾镜下气压弹道[1]。气压弹道在手术中可以将结石快速击碎，但是结石碎片需使用取石钳或加压冲水取出，此过程增加了手术时间，降低了结石清除率[2]。超声碎石虽然可以快速清除结石，但对质地坚硬的结石而言，操作中速度缓慢，效率较低[3]。故本文将超声碎石与经皮肾镜下气压弹道联合应用于肾结石治疗中，取二种手术方式的优势，在粉碎结石的同时将结石碎片快速清除，提高结石清除率，降低肾内压，避免并发症[4]。……