Comparsion of percutaneous nephrolithotomy and retrograde intrarenal surgery for residual kidney stones after percutaneous nephrolithotomy

doi:10.3877/cma.j.issn.1674-3253.2017.05.006

Abstract

Abstract:

Objective

To compare the effect and safety of percutaneous nephrolithotomy and retrograde intrarenal surgery in the treatment of complex kidney stones after one stage percutaneous nephrolithotomy.

Method

The clinical data of 73 patients with residual kidney stone in our hospital from September 2015 to December 2016 were analyzed retrospectively. These patients previously treated with percutaneous nephrolithotomy. These patients were divided into percutaneous nephrolithotomy group and retrograde intrarenal surgery group according to surgical method. Stone clearance rate, operation time, intraoperative hemorrhage, average hospital stay, hospitalization expense and postoperative time of taking nephrostomy tube in the two groups were compared.

Result

There were no significant differences between the two groups in age, sex, body mass index, residual stone total diameter and residual stone location. The intraoperative hemorrhage was (60±17) ml vs (12±6) ml, the difference was statistically significant (P<0.01). The operation time was (35±4) min vs (60±13) min, the difference was statistically significant (P<0.01). The hospitalization expense was (17 118±1 719) yuan vs (24 026±1 013) yuan, the difference was statistically significant (P<0.01). The average hospital stays was (9.0±1.0) d vs (4.0±0.8) d, the difference was statisticallysignificant (P<0.01). The postoperative time of taking nephrostomy tube was (6.2±0.7) d vs (2.8±0.8) d, the difference was statistically significant (P<0.01). The residual stone clearance rate was 73.6% (25/34) vs 92.3% (36/39), the difference was statistically significant (P=0.031). Three patients occurred severe infection after operation in PCNL group, one patient occurred intraoperative massive hemorrhage who was cured by sensitive antibiotic and selective renal artery embolization.

Conclusion

RIRS is a better procedure for treating residual calculi after one stage PCNL, it has higher stone clearance rate, less intraoperative hemorrhage, less postoperative complications, shorter average hospital stay and postoperative time of taking nephrostomy. It was worth to promote in clinical.

Key words: Complex, kidney stones, Percutaneous nephrolithotomy, Ureterscope

Qiang Yuan, Dan Du. Comparsion of percutaneous nephrolithotomy and retrograde intrarenal surgery for residual kidney stones after percutaneous nephrolithotomy[J]. Chinese Journal of Endourology(Electronic Edition), 2017, 11(05): 315-318.

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组别	性别（例）		年龄（岁，±s）	残石总直径（mm，±s）	体质量指数（kg/m²，±s）	左、右肾分布（例）		肾盏分布（例）
组别	男	女	年龄（岁，±s）	残石总直径（mm，±s）	体质量指数（kg/m²，±s）	左	右	上	中	下	多
PCNL组	18	16	40.7±7.8	15.1±3.6	24.3±1.5	18	16	10	8	11	5
RIRS组	21	18	40.9±8.1	14.7±3.6	23.4±1.7	20	19	11	10	15	3
统计值	χ²=0.006		t=-0.086	t=0.472	t=1.125	χ²=0.020		χ²=1.048
P值	0.938		0.641	0.894	0.591	0.887		0.790

组别	性别（例）		年龄（岁，±s）	残石总直径（mm，±s）	体质量指数（kg/m²，±s）	左、右肾分布（例）		肾盏分布（例）
组别	男	女	年龄（岁，±s）	残石总直径（mm，±s）	体质量指数（kg/m²，±s）	左	右	上	中	下	多
PCNL组	18	16	40.7±7.8	15.1±3.6	24.3±1.5	18	16	10	8	11	5
RIRS组	21	18	40.9±8.1	14.7±3.6	23.4±1.7	20	19	11	10	15	3
统计值	χ²=0.006		t=-0.086	t=0.472	t=1.125	χ²=0.020		χ²=1.048
P值	0.938		0.641	0.894	0.591	0.887		0.790

组别	例数	残石清除（例）	术中出血（ml）	手术时（min）	住院费用（元）	平均住院（d）	留置肾造瘘管时间（d）
PCNL组	34	25	60±17	35±4	17 118±1 719	9.0±1.0	6.2±0.7
RIRS组	39	34	12±6	060±13	24 026±1 013	4.0±0.8	2.8±0.8
检验值	?	χ²=4.66	t=15.40	t=-11.40	t=-20.53	t=23.65	t=18.95
P值	?	0.031	<0.001	<0.001	<0.001	<0.001	<0.001

组别	例数	残石清除（例）	术中出血（ml）	手术时（min）	住院费用（元）	平均住院（d）	留置肾造瘘管时间（d）
PCNL组	34	25	60±17	35±4	17 118±1 719	9.0±1.0	6.2±0.7
RIRS组	39	34	12±6	060±13	24 026±1 013	4.0±0.8	2.8±0.8
检验值	?	χ²=4.66	t=15.40	t=-11.40	t=-20.53	t=23.65	t=18.95
P值	?	0.031	<0.001	<0.001	<0.001	<0.001	<0.001

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