切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 259 -262. doi: 10.3877/cma.j.issn.1674-3253.2019.04.011

所属专题: 文献

临床研究

输尿管软镜和体外冲击波治疗单通道经皮肾镜术后残石的比较
何海宝1, 刘锁民2, 张建勋1, 高丹凤1, 王刚1,()   
  1. 1. 716000 陕西,延安市人民医院泌尿外科
    2. 110000 辽宁,中国医科大学第四附属医院泌尿外科
  • 收稿日期:2017-08-09 出版日期:2019-08-01
  • 通信作者: 王刚

Comparison of flexible ureteroscopy and extracorporeal shock wave lithotripsy for residual calculi after single-tract percutaneous nephrolithotomy

Haibao He1, Suomin Liu2, Jianxun Zhang1, Danfeng Gao1, Gang Wang1,()   

  1. 1. Department of Urology, the People's Hospital of Yan'an City, Shanxi 716000, China
    2. Department of Urology, the Fourth Affiliated Hospital of China Medical University, Liaoning 110000, China
  • Received:2017-08-09 Published:2019-08-01
  • Corresponding author: Gang Wang
  • About author:
    Corresponding author: Wang Gang, Email:
引用本文:

何海宝, 刘锁民, 张建勋, 高丹凤, 王刚. 输尿管软镜和体外冲击波治疗单通道经皮肾镜术后残石的比较[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2019, 13(04): 259-262.

Haibao He, Suomin Liu, Jianxun Zhang, Danfeng Gao, Gang Wang. Comparison of flexible ureteroscopy and extracorporeal shock wave lithotripsy for residual calculi after single-tract percutaneous nephrolithotomy[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2019, 13(04): 259-262.

目的

探讨输尿管软镜钬激光碎石(fURS)治疗单通道经皮肾镜碎石取石术(PCNL)治疗复杂性结石后残余结石的临床价值。

方法

回顾性选择2014年1月至2016年12月来我院接受单通道PCNL治疗复杂性肾结石后出现残余结石<20 mm的患者105例。根据处理残石方法不同而分为试验组(fURS,n=60例)和对照组[体外冲击波碎石术(ESWL),n=45例],并分析比较两组患者的一般资料、围手术期参数、并发症的情况。

结果

试验组患者在平均手术时间、手术成功率、结石清除率、需要再次治疗率方面明显优于对照(tχ2分别为6.255,7.415,9.358,10.423;P值分别为<0.001,0.006,0.002,0.001),试验组患者术后疼痛、肾功能减退方面的并发症例数少于对照组,且总的并发症发生率显著低于对照组(χ2=6.369,P=0.012)。

结论

针对单通道PCNL后残余结石的患者,相对于ESWL,fURS治疗后结石清除率更高,且术后并发症的更低,安全性高,值得在临床上推广。

Objective

To investigate the clinical effect between flexible ureteroscopy (fURS) and extrocorporeal shock ware lithotripsy (ESWL) in the treatment of residual stones after the management of complex calculi with single-tract percutaneous nephrolithotomy.

Methods

105 patients with complex calculi in our hospital from Jan 2014 to Dec 2016 were selected as study subjects. Among them, 60 patients accepted fURS after single channel PCNL (test group, n=60), and 45 patients accepted ESWL after single channel PCNL (control group, n=45). General data, perioperative parameters and complications of the two groups were analyzed and compared.

Results

The experimental group were significantly better than the control group in terms of average operation time, operation success rate, stone clearance rate, and the need for re-treatment rate (t or χ2 were 6.255, 7.415, 9.358, 10.423, respectively; P values were 0.000, 0.006, 0.002, and 0.001, respectively). The cases of complications in postoperative pain and renal dysfunction in the experimental group was less than that in the control group, and the overall complication rate in the experimental group was significantly lower than that in the control group (χ2=6.369, P=0.012).

Conclusion

As for patients with residual calculus after single-channel PCNL, compared with ESWL, the stone clearance rate of fURS treatment is higher, and the postoperative complications are lower, with higher safety, which is worthy of clinical promotion.

表1 两组患者临床资料比较
表2 两组患者的手术效果的比较
表3 两组患者并发症发生率的比较(例)
[1]
İbrahim Buldu, Tepeler A, Karatağ T, et al. Combined micro-and standard percutaneous nephrolithotomy for complex renal calculi[J]. Turkish J Urol, 2016, 42(3): 150-154.
[2]
王少刚,余虓. 经皮肾镜碎石取石术的现状与进展[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2016, 10(3): 1-4.
[3]
Zhou Y, Gurioli A, Luo J, et al. Comparison of Effect of Minimally Invasive Percutaneous Nephrolithotomy on Split Renal Function: Single Tract vs Multiple Tracts[J]. J Endourol, 2017, 31(4): 361-365.
[4]
Bozzini G, Provenzano M, Buffi NM, et al. 689 A prospective randomized comparison among SWL, PCNL and RIRS for lower calyceal stones less than 2 cm: A multicenter experience[J]. J Urol, 2016, 195(4): 444-445.
[5]
李旭明,郭闯,程洪林,等. 可拆卸组合式输尿管软镜钬激光碎石术治疗上尿路结石[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2016, 10(5): 29-32.
[6]
刘云峰,陶莹莹. 下尿路结石患者经体外冲击波碎石术后并发症多因素回归分析[J]. 中国临床保健杂志, 2014(6): 646-647.
[7]
Schoenthaler M, Wilhelm K, Hein S, et al. Ultra-mini PCNL versus flexible ureteroscopy: a matched analysis of treatment costs (endoscopes and disposables) in patients with renal stones 10-20 mm[J]. World J Urol, 2015, 33(10): 1601-1605.
[8]
张艳平,刘凯隆,路保赛,等. 软性输尿管镜和经皮肾镜治疗肾结石的疗效及安全性对比分析[J]. 中华泌尿外科杂志, 2014, 35(11): 845-848.
[9]
Fall B, Mouracade P, Bergerat S, et a1. Flexible ureteroscopy and laser lithotripsy for kidney and ureter stone: indications, morbidity and outcome[J]. Prog Urol, 2014, 24(12): 771-776.
[10]
Syed M N A, Haroon N, Ather M. E45 Optimal management of solitary lower pole renal calculi 15-20 millimeters[J]. Euro Urol Suppl, 2011, 10(7): 493-494.
[11]
曾国华,麦赞林,袁坚,等. MPCNL治疗上尿路结石:单中心10452例19年经验报告[J]. 中华泌尿外科杂志, 2012, 33(10): 767-770.
[12]
Qiao M, Zhang H, Zhou C. Factors affecting residual stones after percutaneous nephrolithotomy in patients with renal calculus[J]. Zhonghua Yi Xue Za Zhi, 2015, 95(44): 3617-3619.
[13]
Marguet CG, Springhart WP, Tan YH, et a1. Simultaneous cornbined use of flexible ureteroscopy and percutaneous nephrolithotomy to reduce the number of access tracts in the management of complex renal calculi[J]. BJU Int, 2005, 96(7): 1097-1100.
[14]
曾国华,赵志健,钟文,等. 经皮肾镜取石术联合二期输尿管软镜手术治疗孤立肾复杂性结石的疗效研究[J]. 中华泌尿外科杂志, 2013, 34(4): 268-271.
[15]
Sanguedolee F, Liatsikos E, Verze P, el a1. Use of flexible ureteroseopy in the clinical practice for the treatment of renal stones:results from a large European survey conducted by the EAU Young Academic Urologists-Working Party on Endourology and Urolithiasis [J]. Urolithiasis, 2014, 42(4): 329-334.
[16]
Akman T, Sari E, Binbay M, et al. Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses[J]. J Endourol, 2010, 24(6): 955-960.
[17]
何昊,尹志康,吴小侯,等. 四种微创方式治疗1275例输尿管上段结石的临床研究[J]. 重庆医科大学学报, 2015, 1(5): 758-764.
[18]
Wiesenthal J D, Ghiculete D, D'A Honey R J, et al. A comparison of treatment modalities for renal calculi between 100 and 300 mm2: are shockwave lithotripsy, ureteroscopy, and percutaneous nephrolithotomy equivalent?[J]. Journal of Endourology, 2011, 25(3): 481-485.
[19]
Takazawa R, Kitayama S, Tsujii T. Successful outcome of flexible ureteroscopy with holmium laser lithotripsy for renal stones 2 cm or greater[J]. Int J Urol, 2012, 19(3): 264-267.
[1] 吴春风, 卢国汉, 姚汝贺, 李健辉, 陈文杰, 黄宇. 21 F膀胱镜鞘联合8.0/9.8 F输尿管镜与等离子电切镜在膀胱结石钬激光碎石术中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 579-584.
[2] 莫淇舟, 苏劲, 黄健, 李健维, 李思宁, 柳建军. 智能控压输尿管软镜碎石吸引取石术在直径10~25 mm上尿路结石中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 497-502.
[3] 杜贵伟, 陆勇, 成博, 贺薏, 梁爽. 钬激光碎石术术后联合坦索罗辛治疗对输尿管结石患者的影响分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 491-496.
[4] 李鑫, 邓相奎, 林昌永, 郭勇. 心脏起搏器/心律转复除颤器与体外冲击波碎石相关指南文献解读[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 313-317.
[5] 苏博兴, 肖博, 李建兴. 2024年美国泌尿外科学会年会结石领域手术治疗相关热点研究及解读[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 303-308.
[6] 莫林键, 杨舒博, 农卫赟, 程继文. 人工智能虚拟数字医师在钬激光前列腺剜除日间手术患教管理中的应用[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 318-322.
[7] 张斌, 孙代宇, 胡昕, 韩菲, 李久明, 李功雨, 吴伟力, 冯宝富, 彭国辉. 评分系统预测不同经验手术者输尿管软镜术后结石清除率准确性的比较研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 353-360.
[8] 麦子结, 曾学晴, 张乾升, 刘永达. 输尿管软镜术后严重出血治疗的初步探索[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 366-371.
[9] 莫淇舟, 柳建军, 叶木石, 黄兴端, 李健维, 李思宁, 黄健, 苏劲. 二期原通道经皮肾镜联合输尿管软镜治疗经皮肾镜术后残石[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(04): 380-385.
[10] 詹留松, 刘百川, 赵建朋, 薛国详. 可弯曲负压吸引鞘辅助输尿管软镜钬激光碎石术[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(03): 271-276.
[11] 王思成, 贾斌, 樊体武. 输尿管硬镜腔内操作"运镜八法"运用技巧及总结[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(02): 168-171.
[12] 曾明辉, 蒋东方, 秦锁炳. 钬激光前列腺剜除术治疗前列腺增生疗效的影响因素[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(02): 157-161.
[13] 李云智, 蒋晓峰, 金铭, 杨江华, 李海斌, 赵盟杰, 刘冬, 高国静, 孟繁超, 崔功静, 廖晓星. 输尿管软镜碎石术治疗累计直径>2 cm上尿路结石一期清石率影响因素及预测模型建立[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(01): 58-63.
[14] 冯嘉楠, 蔡磊, 何国林, 付顺军, 张成, 冯周彬, 温耀鸿, 谭洪坤, 潘明新. 腹腔镜胆总管切开探查取石一期缝合的安全性与疗效:附128例分析[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 543-550.
[15] 陈晨, 罗佳, 汪新天, 彭创, 蒋超, 李浩, 王永刚, 何自力, 梁路峰, 王永, 张凝乐, 李业荣, 王涛, 张占国. 一种新型腹腔镜下免气腹硬质内镜钬激光碎石治疗肝内胆管结石的疗效[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(02): 200-204.
阅读次数
全文


摘要