经皮肾镜与输尿管软镜治疗肾下盏小鹿角形结石的比较

doi:10.3877/cma.j.issn.1674-3253.2022.06.010

目的

比较经皮肾镜（PCNL）与输尿管软镜（FURS）治疗肾下盏小鹿角形结石的安全性及有效性。

方法

回顾性纳入并分析我院2017年4月至2019年4月43例肾下盏小鹿角形结石，其中PCNL治疗20例（PCNL组），FURS治疗23例（FURS组），比较两组手术时间、结石清除率、手术并发症和术后住院天数等。

结果

43例均顺利完成手术，PCNL组的手术时间、术后住院天数均显著长于FURS组（P<0.05）；术后1~4 d PCNL组结石清除率85.0%，显著高于FURS组52.2%，术后4周及术后半年两组结石清除率差异无统计学意义（P>0.05），但FURS组的二次干预率更高（P<0.05）；两组在术后发热、出血及石街形成等方面差异无统计学意义（P>0.05），但PCNL组的血红蛋白丢失量及术后止痛药使用率更高（P<0.05）。

结论

PCNL与FURS在治疗肾下盏小鹿角形结石均安全、有效，两者远期疗效相当，但FURS比PCNL创伤更小，术后恢复更快，值得临床推广。

关键词: 经皮肾镜, 输尿管软镜, 肾下盏结石, 鹿角形结石

Objective

To compare the safety and efficacy of percutaneous nephrolithotomy(PCNL) and flexible ureteroscopy(FURS) in treatment of lower pole minor staghorn calculi.

Methods

From April 2017 to April 2019, 43 patients having lower pole minor staghorn calculi were treated with PCNL or FURS in our hospital. The patients were all retrospectively investigated and classified as PCNL group or FURS group. Of them, 20 patients received PCNL and 23 underwent FURS, respectively. The two groups were compared and analyzed statistically in terms of operation time, stone-free rate, surgical-related complications rate and postoperative hospital stay.

Results

Successful surgery had been done in all the patients. Operation time and postoperative hospital stay of the PCNL group were significantly longer than that of the FURS group (P<0.05). In PCNL group, initial stone-free rate(SFR) in 4 days after surgeries achieved 85.0%, which was significantly higher than that of 52.2% in FURS group (P<0.05). However, there was no significant difference between the two groups in terms of overall SFR in 4 weeks and 6 months after surgeries, respectively (P>0.05). Nevertheless, the need for further intervention(staged FURS surgery or ESWL) in the FURS group was significantly more than that in the PCNL group (P<0.05). Complication rate between the two groups was similar in terms of postoperative fever, bleeding and steinstrasse (P>0.05), but the PCNL group suffered more loss of hemoglobin and postoperative pain (P<0.05).

Conclusions

Both PCNL and FURS are safe and feasible for patients with minor renal staghorn calculi in the lower pole. Compared to PCNL, FURS deserves its priority to deal with lower pole minor staghorn calculi for its less invasive and faster postoperative recovery.

Key words: Percutaneous nephrolithotomy(PCNL), Flexible ureteroscopy(FURS), Lower pole stone, Staghorn calculi

表1 两组肾下盏小鹿角形结石患者一般资料比较

组别	例数	年龄[岁，(±s)]	性别(例)		结石侧别(例)		结石最大径[mm，(±s)]	结石分支(例)		肾积水(例)
组别	例数	年龄[岁，(±s)]	男	女	左	右	结石最大径[mm，(±s)]	两个分支	三个分支	有	无
PCNL组	20	61±11	8	12	9	11	19.2±3.6	15	5	4	16
FURS组	23	59±8	14	9	13	10	18.6±4.3	16	7	6	17
统计值		t=0.529	χ²=1.865		χ²=0.568		t=0.410	χ²=0.157		χ²=0.012
P值		0.599	0.172		0.451		0.684	0.692		0.913

表1 两组肾下盏小鹿角形结石患者一般资料比较

组别	例数	年龄[岁，(±s)]	性别(例)		结石侧别(例)		结石最大径[mm，(±s)]	结石分支(例)		肾积水(例)
组别	例数	年龄[岁，(±s)]	男	女	左	右	结石最大径[mm，(±s)]	两个分支	三个分支	有	无
PCNL组	20	61±11	8	12	9	11	19.2±3.6	15	5	4	16
FURS组	23	59±8	14	9	13	10	18.6±4.3	16	7	6	17
统计值		t=0.529	χ²=1.865		χ²=0.568		t=0.410	χ²=0.157		χ²=0.012
P值		0.599	0.172		0.451		0.684	0.692		0.913

表2 两组肾下盏小鹿角形结石患者术中、术后情况比较

组别	例数	手术时间[min，(±s)]	术后住院天数[d，中位数(范围)]	术后1~4 d结石清除率[例(%)]	术后4周结石清除率[例(%)]	术后半年结石清除率[例(%)]	二次干预率[例(%)]
PCNL组	20	106±12	6.5(5.0~14.0)	17(85.0)	17(85.0)	18(90.0)	1(5.0)
FURS组	23	73±11	2.0(1.0~6.0)	12(52.2)	17(73.9)	20(82.6)	9(39.1)
统计值		t=9.358	Z=-5.431	χ²=3.861	χ²=0.266	χ²=0.000	χ²=5.201
P值		<0.001	<0.001	0.049	0.606	1.000	0.023

表2 两组肾下盏小鹿角形结石患者术中、术后情况比较

组别	例数	手术时间[min，(±s)]	术后住院天数[d，中位数(范围)]	术后1~4 d结石清除率[例(%)]	术后4周结石清除率[例(%)]	术后半年结石清除率[例(%)]	二次干预率[例(%)]
PCNL组	20	106±12	6.5(5.0~14.0)	17(85.0)	17(85.0)	18(90.0)	1(5.0)
FURS组	23	73±11	2.0(1.0~6.0)	12(52.2)	17(73.9)	20(82.6)	9(39.1)
统计值		t=9.358	Z=-5.431	χ²=3.861	χ²=0.266	χ²=0.000	χ²=5.201
P值		<0.001	<0.001	0.049	0.606	1.000	0.023

表3 两组肾下盏小鹿角形结石患者并发症比较

组别	例数	术后血红蛋白下降值[g/L，中位数(范围)]	止痛药使用率[例(%)]	发热(>38.5℃)[例(%)]	出血[例(%)]	石街形成[例(%)]
PCNL组	20	26.5(12.0~43.0)	9(45.0)	1(5.0)	2(10.0)	0(0)
FURS组	23	17.0(-16.0~27.0)	2(8.7)	2(8.7)	0(0)	2(8.7)
统计值		Z=-3.361	χ²=5.622	χ²=0.00	-	-
P值		0.001	0.018	1.0000	0.210	0.491

表3 两组肾下盏小鹿角形结石患者并发症比较

组别	例数	术后血红蛋白下降值[g/L，中位数(范围)]	止痛药使用率[例(%)]	发热(>38.5℃)[例(%)]	出血[例(%)]	石街形成[例(%)]
PCNL组	20	26.5(12.0~43.0)	9(45.0)	1(5.0)	2(10.0)	0(0)
FURS组	23	17.0(-16.0~27.0)	2(8.7)	2(8.7)	0(0)	2(8.7)
统计值		Z=-3.361	χ²=5.622	χ²=0.00	-	-
P值		0.001	0.018	1.0000	0.210	0.491

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Comparison of percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of lower pole minor staghorn calculi

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Comparison of percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of lower pole minor staghorn calculi