标准通道经皮肾镜与微通道经皮肾镜取石

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尊敬的编辑、审稿专家：

您好！根据专家意见，我进行了逐条认真修改，在文章用红色标记。请您审阅！

1.在文章中加入了“入选患者均为单侧肾结石，BMI指数介于18.5 —23.9之间”。另外术前血红蛋白水平已在血常规中检测。

2.在结果中已叙述“均一期行碎石术”，在“观察指标”中已叙述是“I期结石清除率”。

3.目前分肾功能检测最好的是ECT，但价格比较贵，普及检测较困难，所以文中检测的是总的GFR。

4.增加了“术后迟发性出血的发生及两组患者术后感染等并发症发生率的情况”。

微通道与标准通道经皮肾镜取石术治疗肾

结石的疗效观察

刘升学*孙文国*蒋雷鸣**覃展偶张天禹贺徐华（桂林医学院附属医院，泌尿外科，广西桂林 541001）Comparison of Clinical Effect Between mPCNL and PCNL in the Treatment for Renal Calculi Liu shengxue Sun wenguo Jiang leiming Qin zhan’ou Zhang tianyu He xuehua

(Affiliated Hospital of Giulin Medical University, guangxi 541001, China) [Abstract]Objective:To compare the efficacy and advantages of

基金项目：广西壮族自治区卫生厅课题（Z2007214）。

**通讯作者：蒋雷鸣，主任医师，硕士生导师，主要从事泌尿外科、男科学研究。

*第一作者：刘升学，医学硕士生，主治医师。孙文国，医学硕士研究生。

standard percutaneous nephrolithotomy (PCNL) and mini-percutaneous nephrolithotomy (mPCNL) in the treatment of renal calculi, improve the treatment of kidney stones. Methods: From Jan. 2009 to July 2012, application of B-guided PCNL was performed in 194 patients and mPCNL in 178 patients. Statistics the stone-free rate and effcts on renal function. Results:18F and 24F percutaneous renal access were successfully established in PCNL and mPCNL group respectively. The PCNL group had a shorter operation time than the mPCNL group. The one-stage stone-free rate for multiple stones was significantly higher in the mPCNL group than in the PCNL group. However, the rate for simple renal pelvis stone was significantly lower in the mPCNL group than in the PCNL group. There was no statistical difference in the one-stage stone-free rate for staghorn stone, complications rate, renal function, blood transfusion, and postoperative hospital stay between the two groups. The blood loss in mPCNL was less than in PCNL group, but the rate of blood transfusion and the remaining was no significant difference. First and third days and one month, the Cr was more in both group, and greater in mPCNL. GFR had dedined in the first day and greater in mPCNL, and three day later the GFR retuned to normoal. Conclusion: The PCNL may be suitable for large renal stone, while mPCNL may has advantages in the treatment for renal calyx stone. PCNL is less than mPCNL on renal function. Renal function impairment caused by expansion in the establishment of channel process is far lower than caused by the perfusion pressure.

Key Words:urinary calculi; percutaneous nephrolithotripsy; renal function; urolithiasis

摘要目的探讨微通道经皮肾镜碎石取石术（mPCNL）与标准通道经皮肾镜碎石取石术(标准通道PCNL)治疗肾结石的有效性及优缺

点，提高肾结石的治疗水平。方法2009年1月-2012年7月，应用B超引导下mPCNL与标准通道PCNL分别治疗178例和194例肾结石。统计结石清除率及对肾功能的影响等。结果mPCNL组与标准通道PCNL组一期分别建立F18和F24肾穿刺通道。标准通道PCNL 组手术时间比mPCNL组缩短(P<0.05)；单纯肾盂结石一期清除率高于mPCNL组(P<0.05)；而mPCNL组对肾盏多发性结石患者一期结石清除率高于标准通道PCNL组(P<0.05)。mPCNL组术中出血量明显少于标准通道PCNL组(P<0.05)，但输血率及留管时间差异无统计学意义（P>0.05）。两组患者术后第1天、第3天及1个月的血肌酐Cr较术前有所升高，mPCNL组较标准通道PCNL组变化更大（P＜0.05）；肾小球滤过率GFR在术后第1天出现一过性的下降，mPCNL 组比标准通道PCNL组下降更大（P＜0.05），3天后基本恢复正常。结论较大的肾盂结石优选标准通道PCNL，肾盏多发结石首选考虑用mPCNL处理。标准通道PCNL对患者肾功能的影响要小于mPCNL。建立通道扩张所引起的肾功能的损害要小于灌注压力的危害。

关键词：肾结石；经皮肾镜取石术；肾功能；尿石症

中图分类号：R699.4 文献标识码：A

经皮肾镜取石术(percutaneous nephrolithotomy，PCNL)己逐步取代传统开放式手术(1)，成为治疗2cm以上肾结石的首先方法。根据手术通道的大小，PCNL分为微通道(mPCNL)和标准通道PCNL手术。F24-30为标准通道，F20以下为微通道，在治疗肾结石上各有优势。本院自2009年1月至2012年7月行经皮肾镜碎石取石术治疗肾结石372例，对照分析两组治疗效果，现报告如下。

1. 资料和方法