后腹腔镜肾囊肿去顶联合经皮肾穿刺碎石术在肾囊肿合并肾或输尿管上段结石患者中的应用研究

摘要

目的：对比分析同期与分期后腹腔镜肾囊肿去顶联合经皮肾穿刺碎石术治疗肾囊肿合并肾或输尿管上段结石的效果，探讨同期后腹腔镜肾囊肿去顶联合经皮肾穿刺碎石术的临床价值。方法：选取2010年1月至2013年12月来医院就诊的肾囊肿合并肾或输尿管上段结石患者共80例作为研究对象，采用随机数表法随机分为观察组和对照组，每组40例。观察组行同期联合治疗，对照组行分期治疗；比较两组手术用时、出血量、术后胃肠功能恢复时间、术后下床活动天数、术后住院天数、结石清除率、囊肿及结石复发率、并发症发生情况，对同期联合手术的临床价值进行评价。结果：观察组手术时间、手术出血量、胃肠功能恢复时间、术后住院时间均明显低于对照组，差异均具有统计学意义（ P＜0．05）；观察组术后下床时间低于对照组，但差异不具有统计学意义（ P＞0．05）。观察组结石清除率、术后3月囊肿复发率和结石复发率与对照组比较无明显差异，差异不具有统计学意义（ P＞0．05）。观察组在皮下气肿、肾周积液、感染、血尿、输尿管损伤等并发症发生情况方面与对照组无明显差异，差异不具有统计学意义（ P＞0．05）。结论：同期与分期后腹腔镜肾囊肿去顶术联合经皮肾穿刺碎石术疗效相似，但同期手术能明显减少手术时间、减少术中失血量、加快患者恢复、降低患者住院费用，对于临床具有重要价值。%Objective:To compare and analyse the clinical efficacy of the same period and stages of ret-roperitoneal laparoscopic renal cyst unroofing ( RLRCU ) combined with minimally invasive percutaneous nephrolithotomy ( MIPNL) in the treatment of renal cyst combined with renal or upper ureteral calculi , to dis-cuss the clinical value of RLRCU combined with MIPNL .Method:From Jan.2010 to Dec.2013, selected 80 cases of renal cyst combined with renal or upper ureteral calculi treated in our hospital as study objects . They were randomly divided into observation group and control group by random number table method , each group with 40 patients.The observation group received same period RLRCU combined with MIPNL treat-ment, the control group received stages RLRCU combined with MIPNL treatment .Compare and analysis the efficacy difference between the two groups in operation time , intraoperative blood soss , postoperative gastro-intestinal function recovery time , postoperative ambulation time , postoperative hospital stay , stone clearance rate, cysts and stone recurrence rate and the occurrence of complications .and then evaluated the clinical val-ue of same period operation .Result:The observation group were significantly lower than the control group in operative time, blood loss, postoperative recovery of gastrointestinal function , postoperative hospital stay , the differences were statistically significant ( P <0.05) .The observation group was lower than the control group in postoperative ambulation time , but the difference was not statistically significant ( P>0.05) .There was no significant difference between the two groups in stone clearance rate , cyst recurrence rate , stone recurrence rate 3months after the operation, but the differences were not statistically significant (P>0.05).There was no significant difference between the two groups in subcutaneous emphysema , kidney peripheral effusion , in-fection, hematuria, ureteral injury and other aspects of the complications occurrence , the differences were not statistically significant (P>0.05).Conclusion: The same period and stages of RLRCU combined with MIPNL treatment have similar clinical efficacy , but the same period operation can significantly reduce the operation time , blood loss , accelerate patient recovery , and reduce hospital costs of patients , it has great value to the clinic application .