2021 年第 8 期 第 16 卷

后腹腔镜肾盂切开取石术和经皮肾镜碎石取石术治疗老年患者肾盂结石的临床效果比较

Comparison of clinical effects of retroperitoneal laparoscopic pyelolithotomy and percutaneous nephrolithotomy on elderly patients with renal pelvis stones

作者：黄伟1周凤其2庄建1郭环宇1

英文作者：Huang Wei1 Zhou Fengqi2 Zhuang Jian1 Guo Huanyu1

单位：1山东中医药大学第二附属医院泌尿外科，济南250001；2重庆市石柱县中医院外二科409199

英文单位：1Department of Urology Surgery the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine Jinan 250001 China; 2Second Department of External Medicine Traditional Chinese Medicine Hospital of Shizhu Chongqing 409199 China

关键词：肾盂结石；后腹腔镜肾盂切开取石术；经皮肾镜碎石取石术；结石一次性清除率；肾功能

英文关键词：Renalpelvisstones;Retroperitoneallaparoscopicpyelolithotomy;Percutaneousnephrolithotomy;One-timestoneclearancerate;Renalfunction

• 摘要：

• 目的 比较后腹腔镜肾盂切开取石术(RLP)和经皮肾镜碎石取石术(PCNL)治疗老年患者肾盂结石的临床效果。方法 收集2019年2月至2020年6月山东中药大学第二附属医院泌尿外科收治的90例老年肾盂结石患者的临床资料行回顾性分析。依据手术方式不同分为RLP组和PCNL组，各45例。比较2组患者手术及住院相关指标、结石一次性清除率、肾功能及血红蛋白水平、术后并发症。结果 2组患者手术时间比较差异无统计学意义（P>0.05）；RLP组术中失血量、住院时间、治疗总费用少于/短于PCNL组［（65±12）ml比（118±15）ml、（4.5±0.6）d比（6.5±0.6）d、（1.39±0.22）万元比（1.95±0.31）万元］，差异均有统计学意义（均P<0.05）。2组结石一次性清除率比较差异无统计学意义（P>0.05）。RLP组术后第1天血清γ-谷氨酰转肽酶、血尿素氮、血肌酐水平明显低于PCNL组，血红蛋白水平高于PCNL组，差异均有统计学意义（均P<0.05）。RLP组并发症发生率低于PCNL组［11.1%（13/45）比28.9%（13/45）］，差异有统计学意义（P<0.05）。结论 RLP和PCNL治疗老年肾盂结石患者结石一次性清除率相当，但前者费用相对低廉，在减少术中出血，缩短住院时间，降低术后并发症发生率方面有积极作用，且对肾功能及血红蛋白水平的不良影响较小，是老年肾盂结石的有效手段。

• Objective To compare the clinical effects of retroperitoneal laparoscopic pyelolithotomy(RLP) and percutaneous nephrolithotomy(PCNL) on elderly patients with renal pelvis stones. Methods From February 2019 to June 2020, clinical data of 90 elderly patients with renal pelvis stones admitted to Department of Urology Surgery, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were retrospectively analyzed. They were divided into RLP group and PCNL group according to operation methods, with 45 cases in each group. The operation and hospitalization related indexes, one-time stone clearance rate, renal function, hemoglobin level and postoperative complications were compared between the two groups. Results There was no significant difference in the operation time between the two groups(P>0.05); the intraoperative blood loss, length of stay, the total cost of treatment in RLP group were lower/shorter than those in PCNL group［（65±12）ml vs （118±15）ml, （4.5±0.6）d vs （6.5±0.6）d, （13.9±2.2）thousand yuan vs （19.5±3.1）thousand yuan］(all P<0.05). There was no significant difference in the one-time stone clearance rate between the two groups(P>0.05). The levels of serum γ-glutamyl transpeptidase, blood urea nitrogen and serum creatinine in RLP group were significantly lower than those in PCNL group, and the level of hemoglobin in RLP group was significantly higher than that in PCNL group(all P<0.05). The incidence of complications in RLP group was significantly lower than that in PCNL group［11.1%（13/45） vs 28.9%（13/45）］(P<0.05). Conclusion  The one-time stone clearance rate of RLP and PCNL in the treatment of elderly patients with renal pelvis stones is similar, but the former is relatively low cost, has a positive role in reducing intraoperative bleeding, shortening length of stay and reducing the incidence of postoperative complications, and has smaller adverse effect on renal function and hemoglobin level, so it is an effective method for elderly patients with renal pelvic stones.