摘要
目的比较经皮肾镜大功率钬激光碎石术(HP-HLL)与超声碎石术(US-L)治疗鹿角形肾结石的临床疗效。方法将2014年6月至2016年6月在我院泌尿外科治疗的120例鹿角形肾结石患者作为研究对象,根据随机数表法分为HP-HLL组(60例)和US-L组(60例)。所有患者都进行标准的俯卧位经皮肾取石术(PCNL)治疗。HPHLL组患者采用100 W钬激光仪以40~60 W(2 J,20~30 Hz)的参数进行碎石消解清除。US-L组使用EMS超声碎石机消解清除结石。比较两组患者Ⅰ期结石清除率、3个月后的结石清除率、手术并发症、术中出血量、手术时间、住院时间、血红蛋白下降值、肾小球滤过率。结果 13例患者未能随访,最终入选107例,其中HP-HLL组55例,US-L组52例。HP-HLL组患者的手术时间为(118.25±36.11)min,明显长于US-L组的(81.20±21.53)min,术中出血量为(116.3±26.5)mL,明显多于US-L组的(91.62±28.3)mL,患者的血红蛋白下降值为(1.3±0.6)g/dL,明显小于USL组的(1.7±0.9)g/dL,组间比较差异均具有统计学意义(P<0.05);HP-HLL组和US-L组患者的住院时间[(6.8±1.9)vs(6.4±2.1)d]、肾小球滤过率(14.6%vs 9.6%)、Ⅰ期结石清除率(74.5%vs 69.2%)、3个月后的结石清除率(89.1%vs86.5%)以及术后并发症(20.0%vs 19.2%)比较,差异均无统计学意义(P>0.05)。结论与在PCNL期间用于体内碎石的US-L碎石术相比,HP-HLL拥有较低的血红蛋白下降值,显示较好的安全性和有效性。
Objective To compare curative effect of high-power holmium laser lithotripsy （HP-HLL） and ultrasonic lithotripsy （US-L） for disintegration of staghorn stones during percutaneous nephrolithotomy （PCNL）. Methods From June 2014 to June 2016, a total of 120 patients with staghorn stones hospitalized in our hospital were selected and divided into HP-HLL group and US-L group according to the random number table method, with 60 cases in each group. A standard PCNL in the prone position was performed for all patients. In the HP-HLL group, a laser power of 40~60 W （2 J, 20~30 Hz） was used to pulverise the staghorn stone into very small fragments, which could pass through the Amplatz sheath with the irrigation fluid. US-L, with suction of the fragments, was used in the US-L group. The stone-free rate of Ⅰ session and after 3 months, complications, intraoperative blood loss, operative time, hospital stay, haemoglobin deficit, glomerular filtration rate （GFR） were compared. Results Excluding non-follow-up patients, the final analysis included 107 patients, 55 in the HP-HLL group and 52 in the US-L group. Operative time of US-L group was （81.20±21.53） min, which was significantly shorter than （118.25±36.11） min of HP-HLL group （P〈0.05）. The intraoperative blood loss of HP-HLL group was （116.3±26.5） mL which was significantly more than （91.62±28.3） mL of US-L group （P〈0.05）. The haemoglobin deficit of HP-HLL group was （1.3 ± 0.6） g/dL, which was significantly lower than （1.7±0.9） g/dL in the US-L group （P〈0.05）. The differences length of hospital stay, （6.8±1.9） d for HP-HLL group vs （6.4 ± 2.1） d for US-L group, changes of GFR （14.6% for HP-HLL vs 9.6% for US-L）, stone-free rate of Ⅰ session （74.5%for HP-HLL vs 69.2%for US-L） and after 3 months （89.1%for HP-HLL vs 86.5%for US-L） and complication rates （20.0%for HP-HLL vs 19.2%for US-L） were not significant （P〉0.05）. Conclusion Compared with US-L for in-tracorporeal lithotripsy of staghorn stones during PCNL, HP-HLL showed better safety and efficacy with a lower haemo-globin deficit.
出处
《海南医学》
CAS
2017年第10期1587-1589,共3页
Hainan Medical Journal
关键词
经皮肾镜碎石
鹿角形结石
激光碎石术
超声波碎石术
疗效
Percutaneous nephrolithotomy （PCNL）
Staghorn stones
Laser lithotripsy
Ultrasonic lithotripsy（US-L）
Curative effect
