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目的:比较微创肾镜与输尿管镜在微创经皮肾穿刺取石术(mPCNL)治疗上尿路结石中的有效性及安全性。方法:回顾性分析2009年5月～2010年4月由同一医师应用mPCNL(一期单通道)治疗213例上尿路结石患者的临床资料:微创肾镜组125例,结石平均直径3.4 cm,鹿角形结石84例,肾盏多发结石29例,肾盂结石及输尿管上段结石12例;输尿管镜组88例,结石平均直径3.2 cm,鹿角形结石49例,肾盏多发结石17例,肾盂结石及输尿管上段结石22例。对比分析两组的手术时间、结石清除率、手术出血量、术中灌注液量及手术并发症。结果:所有患者手术均获成功.无严重手术并发症发生。两组结石大小差异无统计学意义,微创肾镜组的手术时间及手术出血量分别为(32±11)min及(65±18)ml,明显低于输尿管镜组(48±15)min和(84±23)ml,而微创肾镜组的术中灌注液量高于输尿管镜组,分别为(15.0±2.6)L及(11.0±1.4)L。两组结石清除率及手术并发症差异无统计学意义。结论:微创肾镜是一种新型、安全、有效的内镜设备,能明显提高手术效率,值得临床推广。
Objective: To compare the effectiveness and safety of minimally invasive nephrolithotomy with ureteroscopy in the treatment of upper urinary calculi with minimally invasive percutaneous nephrolithotomy (mPCNL). Methods: The clinical data of 213 patients with upper urinary tract calculi treated with mPCNL (one-stage single-channel) from May 2009 to April 2010 were retrospectively analyzed. Among them, 125 patients underwent minimally invasive nephrolithotomy with an average diameter of 3.4 cm , 84 cases of antler-shaped stones, multiple calyceal stones in 29 cases, renal pelvis stones and upper ureteral stones in 12 cases; ureteroscopy group of 88 cases, the average diameter of stones 3.2 cm, 49 cases of antler stones, calyx multiple stones in 17 cases, And upper ureteral stones in 22 cases. The operative time, stone clearance, operative bleeding volume, intraoperative perfusion volume and operative complications were compared between the two groups. Results: All patients underwent successful surgery. No serious complications occurred. There was no significant difference in the size of stones between the two groups. The operation time and the amount of bleeding after operation in minimally invasive nephrolithotomy group were (32 ± 11) min and (65 ± 18) ml, which were significantly lower than those in ureteroscope group (48 ± 15) min And (84 ± 23) ml, respectively. However, the intraoperative perfusion volume in the minimally invasive nephroscope group was significantly higher than that in the ureteroscope group (15.0 ± 2.6) L and (11.0 ± 1.4) L, respectively. There was no significant difference between the two groups in stone clearance rate and surgical complications. Conclusion: Minimally invasive nephroscopy is a new, safe and effective endoscopic device that can significantly improve the efficiency of surgery and is worthy of clinical promotion.