微创经皮肾镜取石术联合输尿管软镜治疗复杂性肾结石临床系列研究..doc

同期与分期微创经皮肾镜取石术结合输尿管软镜治疗复杂性肾结石的对比研究 [摘要] 目的：探讨同期与分期微创经皮肾镜取石术结合输尿管软镜治疗的复杂性肾结石病疗效及安全性，希望探讨一种更合理、更适合于临床的手术分期方法。方法：2013年6月至2014年5月间经影像学确诊的复杂性肾结石患者68例根据手术情况分为同期组和分期组，均行经皮肾镜取石术联合输尿管软镜取石术，比较同期组与分期组患者结石清除率与残留率、术后下床时间与住院时间、并发症等。结果：68例复杂性肾结石患者均碎石取石成功，其中同期组46例中，有4例因术中各类因素改为分期手术。术后结石清除率达91.2%（62/68）。残留6例，包括上盏3例，中盏1例，上中盏均残留1例，无下盏残留。同期组结石清除率90.5%，残留率9.5%；分期组结石清除率92.3%，残留率7.7%，两组间数据比较无统计学差异（P0.05）。同期组患者与分期组患者术后下床活动时间比较无统计学差异（P0.05），但同期组患者平均住院时间显著短于分期组，两组间数据比较具有统计学意义（P0.01）。同期组患者术后并发症发生率为4.8%，显著低于分期组23.1%；其中同期组感染发生率显著低于分期组，两组间数据比较具有显著差异（P0.05）；两组间输尿管损伤发生率与尿瘘发生率比较无统计学差异（P0.05）。结论：同期经皮肾镜取石术联合输尿管软镜治疗复杂性肾结石具有并发症少、术后感染率低等特点，但选择同期或分期手术仍应结合术前评估、术中操作、手术时间、患者意愿、术者经验等。 [关键词] 微创手术，经皮肾镜取石术，输尿管软镜，复杂性肾结石 Comparative study of same period and staging period of minimally invasive percutaneous nephrolithotomy surgery combined with flexible ureteroscope treatment of complex renal calculi [Abstract] Objective: To explore the efficacy and safety of same period and staging period of minimally invasive percutaneous nephrolithotomy surgery combined with flexible ureteroscope treatment of complex renal calculi, wish to explore a more reasonable and more suitable for clinical surgery staging. Methods: 68 patients with complex renal calculi between June 2013 to May 2014 confirmed by imaging were divided into the same period group and staging group according to surgical case, all were given percutaneous nephrolithotomy surgery combined with flexible ureteroscope lithotomy, stone clearance rate and the residual rate, postoperative ambulation time and hospital stay, and complications and so on of the same period group and staging group were compared. Results: Lithotripsyof 68 cases of patients with complex renal calculi was success, in which, 4 cases in the same period group 46 cases due to various of factors intraoperative underwent staging surgery. Postoperative stone clearance rate was 91.2% (62/68). Residual 6 cases, including 3 cases of lamp, 1 case of light, 1 case both of lamp and light, no residue under