微创经皮肾镜与输尿管软镜治疗2～4 cm肾下盏结石的比较

doi:10.3877/cma.j.issn.1674-3253.2018.02.011

中华腔镜泌尿外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (02) : 111 -115. doi: 10.3877/cma.j.issn.1674-3253.2018.02.011

所属专题：文献；

临床研究

微创经皮肾镜与输尿管软镜治疗2～4 cm肾下盏结石的比较

张宇¹, 李九智², 姜有涛², 张国飞³, 吴越³^,^†(

)

^1. 518102　深圳市宝安区中心医院泌尿外科
^2. 830011　乌鲁木齐，新疆维吾尔自治区人民医院泌尿外科中心
^3. 830000　乌鲁木齐，新疆医科大学第六附属医院泌尿外科

收稿日期:2017-04-24 出版日期:2018-04-01
通信作者: 吴越
基金资助:
深圳市宝安区医疗卫生科研项目(2016CX049)

Comparative analysis of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery in management of lower pole renal stones (2~4 cm)

Yu Zhang¹, Jiuzhi Li², Youtao Jiang², Guofei Zhang³, Yue Wu³^,^†()

^1. Department of Urology, Bao'an Central Hospital of Shen Zhen, Guangdong 518102, China
^2. People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830011, China
^3. Department of Urology, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China

Received:2017-04-24 Published:2018-04-01
Corresponding author: Yue Wu
About author:
Corresponding author: Wu Yue, Email: 534712074@qq.com

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引用本文：

张宇, 李九智, 姜有涛, 张国飞, 吴越. 微创经皮肾镜与输尿管软镜治疗2～4 cm肾下盏结石的比较[J]. 中华腔镜泌尿外科杂志(电子版), 2018, 12(02): 111-115.

Yu Zhang, Jiuzhi Li, Youtao Jiang, Guofei Zhang, Yue Wu. Comparative analysis of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery in management of lower pole renal stones (2~4 cm)[J]. Chinese Journal of Endourology(Electronic Edition), 2018, 12(02): 111-115.

目的

比较微创经皮肾镜碎石取石术（MPCNL）和输尿管软镜碎石术（RIRS）治疗2～4 cm肾下盏结石的效果。

方法

我们回顾性分析新疆医科大学第六附属医院、深圳市宝安区中心医院和新疆自治区人民医院三家医院从2011年6月至2016年6月治疗直径范围2～4 cm肾下盏结石167例病例资料，根据手术方式不同分为两组：MPCNL 98例，RIRS 69例。

结果

MPCNL组手术时间（84±28）min，短于RIRS组（116±23）min（P<0.001）；MPCNL术中血红蛋白下降值（5.2±1.6）g/L,明显高于RIRS组（1.9±0.4）g/L（P<0.001）；住院时间（8.5±1.4）d，明显长于RIRS组（3.8±1.2）d（P<0.001）；术后并发症率MPCNL组14.3％（14/98）高于RIRS组4.3％（3/69）（P=0.036）；MPCNL一期清石率87.8％（86/98）高于RIRS组55.1％（38/69）（P<0.001）；总清石率分别为93.9％（92/98）和91.3％（63/69），两者接近（P=0.506）。

结论

MPCNL是治疗2～4 cm肾下盏结石的有效手段，但为了更加微创、出血更少、住院时间更短，RIRS在一定程度上可以作为治疗肾下盏结石的一种有效的替代手术方式。

关键词: 肾结石，下盏, 经皮肾镜, 输尿管镜

Objective

To compare the efficacy of MPCNL and RIRS in lower pole renal stones 2-4 cm in diameter.

Methods

A total of 167 patients who underwent MPCNL or RIRS for lower pole stone 2-4 cm in diameter between June 2011 and June 2016 were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both MPCNL and RIRS before the selection of the procedure. Patients were divided into two groups according to the patients' surgery type. Group 1 consisted of 98 patients who underwent MPCNL and Group 2 consisted of 69 patients treated with RIRS. Stone free statuses, postoperative complications,operative time and hospitalization time were compared in both groups.

Results

The mean operation time was (84±28) min vs (116 ±23) min(P<0.001); The mean hemoglobin drop value was (5.2±1.6) g/L vs (1.9±0.4) g/L (P<0.001); The postoperative hospital stay was(8.5 ± 1.4) d for MPCNL, which was longer than that of the RIRS group (3.8 ± 1.2) d (P<0.001). The respective complication rates were 14.3% (14/98) and 4.3%(3/69) (P=0.036). In MPCNL group, stone-free rate was 87.8% (86/98) at first session and 93.9% (92/98) after the additional procedure. In RIRS group, stone-free rate was 55.1%(38/69) at the first procedure and 91.3%(63/69) after the additional procedure. The final stone-free rates were similar in both groups (P=0.506).

Conclusions

MPCNL is an effective method for the treatment of lower pole stones 2-4 cm in diameter. RIRS should be an effective treatment alternative to MPCNL in lower pole stones, especially in selected patients.

Key words: Renal stone, lower pole, Percutaneous nephrolithotomy, Ureteroscope

表1 两组患者术前一般情况比较

组别	例数	年龄(岁，)	性别（例）		结石大小（mm，±s）	下盏位置（例）		结石所在肾脏位置（例）		肾积水程度（例）		随访时间（月，±s）
组别	例数	年龄(岁，)	男	女	结石大小（mm，±s）	前组	后组	左	右	轻度	中度	随访时间（月，±s）
MPCNL组	98	40±12	65	33	28±6	21	77	51	47	16	12	13±4
RIRS组	69	40±14	46	23	26±8	13	56	36	33	9	6	12±3
t/χ²值	?	t=-0.296	χ²=0.002		t=1.681	χ²=0.167		χ²=0.001		χ²=1.019		t=0.565
P值	?	0.768	0.963		0.095	0.683		0.986		0.601		0.573

表1 两组患者术前一般情况比较

组别	例数	年龄(岁，)	性别（例）		结石大小（mm，±s）	下盏位置（例）		结石所在肾脏位置（例）		肾积水程度（例）		随访时间（月，±s）
组别	例数	年龄(岁，)	男	女	结石大小（mm，±s）	前组	后组	左	右	轻度	中度	随访时间（月，±s）
MPCNL组	98	40±12	65	33	28±6	21	77	51	47	16	12	13±4
RIRS组	69	40±14	46	23	26±8	13	56	36	33	9	6	12±3
t/χ²值	?	t=-0.296	χ²=0.002		t=1.681	χ²=0.167		χ²=0.001		χ²=1.019		t=0.565
P值	?	0.768	0.963		0.095	0.683		0.986		0.601		0.573

表2 两组患者治疗结果的比较

?	一期结石清除率[例（%）]	总结石清除率[例（%）]	手术时间（min，±s）	血红蛋白下降值（g/L，±s）	住院时间（d，±s）	并发症[例（%）]
MPCNL组	86(87.8)	92(93.9)	084±28	5.2±1.6	8.5±1.4	14(14.3)
RIRS组	38(55.1)	63(91.3)	116±23	1.9±0.4	3.8±1.2	3(4.3)
t/χ²值	χ²=22.622	χ²=0.402	t=7.872	t=16.754	t=22.636	χ²=4.374
P值	<0.001	0.506	<0.001	<0.001	<0.001	0.036

表2 两组患者治疗结果的比较

?	一期结石清除率[例（%）]	总结石清除率[例（%）]	手术时间（min，±s）	血红蛋白下降值（g/L，±s）	住院时间（d，±s）	并发症[例（%）]
MPCNL组	86(87.8)	92(93.9)	084±28	5.2±1.6	8.5±1.4	14(14.3)
RIRS组	38(55.1)	63(91.3)	116±23	1.9±0.4	3.8±1.2	3(4.3)
t/χ²值	χ²=22.622	χ²=0.402	t=7.872	t=16.754	t=22.636	χ²=4.374
P值	<0.001	0.506	<0.001	<0.001	<0.001	0.036

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