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目的:探讨微肾镜取石术(MPCNL)联合大功率钬激光与大通道经皮肾镜取石术(PCNL)治疗老年复杂肾结石的疗效及安全性,为老年复杂肾结石PCNL治疗通道的选择提供参考。方法:选择老年复杂肾结石患者92例,随机分为MPCNL组(n=47)和大通道组(n=45),MPCNL组采用MPCNL治疗,大通道组采用大通道PCNL治疗,比较两组手术时间、术中出血量、一次结石取净率、尿液转清时间、术后住院时间、并发症发生情况和肾功能恢复情况。结果:MPCNL手术时间长于大通道组,术中出血量、并发症发生率明显低于大通道组(P<0.05)。两组一次结石取净率差异无统计学意义(P>0.05),MPCNL组术后尿液转清时间、术后住院时间、肾造瘘管留置时间明显短于大通道组(P<0.05)。MPCNL组患者血肌酐水平于术后24 h达高峰,术后30 d恢复至术前水平;大通道组血肌酐水平术后48 h达高峰,术后30 d仍高于术前水平。MPCNL组血肌酐术后24 h、48 h、7 d、30 d均明显低于大通道组(P<0.05)。结论:MPCNL较大通道PCNL术中出血量、并发症明显减少,术后肾功能恢复更快,安全性更高,是老年复杂肾结石患者较适宜的一种术式。
Objective: To investigate the efficacy and safety of micro-nephrolithotomy (MPCNL) combined with high-power holmium laser and large-channel percutaneous nephrolithotomy (PCNL) in the treatment of senile complex nephrolithiasis and provide the options for the treatment of PCNL in elderly patients with complex calculi reference. Methods: Ninety-two elderly patients with complex nephrolithiasis were randomly divided into two groups: MPCNL group (n = 47) and MPA group (n = 45). MPCNL group was treated with MPCNL and large-channel PCNL group. Time, intraoperative blood loss, primary stone removal rate, urine clearance time, postoperative hospital stay, complications and renal function recovery. Results: The operation time of MPCNL was longer than that of the large channel group. The blood loss and complication rate of the MPCNL group were significantly lower than those of the large channel group (P <0.05). There was no significant difference in the rates of primary stone removal between the two groups (P> 0.05). The urinary clearance time, postoperative hospital stay and renal fistula indwelling time in MPCNL group were significantly shorter than those in the large channel group (P <0.05). The level of serum creatinine in MPCNL patients peaked at 24 hours after operation and returned to the preoperative level at 30 days after operation. Serum creatinine reached a peak at 48 hours after operation in the large channel group, and remained higher than preoperative levels at 30 days. Serum creatinine in MPCNL group was significantly lower than that in large channel group at 24 h, 48 h, 7 d and 30 d after operation (P <0.05). Conclusion: The amount of bleeding and the complication of MPCNL in the pathways of PCNL are significantly reduced. The postoperative recovery of renal function is quicker and the safety is higher. It is a suitable surgical procedure for complex nephrolithiasis in the elderly.