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目的探讨气压弹道碎石法与钬激光碎石法在微创经皮肾镜取石术中的应用选择。方法选择128位肾结石患者,根据其易碎性分为易碎结石组60例,不易碎结石组68例。每组又随机分为气压弹道碎石组和钬激光碎石组,比较两种碎石方法的临床疗效。结果在易碎结石组中气压弹道碎石的手术时间(65.2±12.7)min,钬激光碎石的手术时间(85.3±10.4)min,二者差异有统计学意义(P<0.05),两种方法的一期成功率及大出血发生率差异无统计学意义(P>0.05)。在不易碎结石组中气压弹道碎石的手术时间为(125.4±14.5)min,钬激光碎石的手术时间(96.0±12.9)min,二者差异有统计学意义(P<0.05),并且钬激光碎石法大出血发生率低于气压弹道碎石法的发生率(P<0.05),其一期手术成功率高于气压弹道碎石法的一期手术成功率(P<0.05)。结论对易碎结石者宜选择气压弹道碎石法,对不易碎结石者宜选择钬激光碎石法;术中判断结石的易碎性可为合理选择碎石方法提供依据。
Objective To explore the application of pneumatic lithotripsy and holmium laser lithotripsy in minimally invasive percutaneous nephrolithotomy. Methods 128 patients with kidney stones were selected. According to their fragility, they were divided into friable calculus group (60 cases) and non-fragile calculus group (68 cases). Each group was randomly divided into pneumatic lithotripsy group and holmium laser lithotripsy group, comparing the clinical efficacy of two kinds of gravel method. Results The operative time of pneumatic lithotripsy (65.2 ± 12.7) min and the operative time of holmium laser lithotripsy (85.3 ± 10.4) min in the friable calculus group were significantly different (P <0.05) The success rate of the first phase and the incidence of major bleeding were not statistically different (P> 0.05). The operative time of pneumatic lithotripsy in the group of non-fragile stones was (125.4 ± 14.5) min and that of holmium laser lithotripsy was (96.0 ± 12.9) min, the difference was statistically significant (P <0.05) The incidence of major bleeding with laser lithotripsy was lower than that with pneumatic lithotripsy (P <0.05). The success rate of the first stage operation was higher than that of the first stage operation of pneumatic lithotripsy (P <0.05). Conclusions The pneumatic lithotripsy should be chosen for the patients with fragile stones, and the holmium laser lithotripsy should be chosen for the patients with non-fragile stones. The determination of the fragility of the stones during operation can provide the basis for the reasonable choice of the gravel method.