摘要
目的比较输尿管软镜(flexible ureteroscopic lithotripsy,fURSL)及微造瘘经皮肾镜碎石(miniaturized percutaneous nephrolithotomy,MPCNL)处理2~3 cm肾下盏结石的疗效。方法回顾性分析我院2018年6月~2019年4月85例2~3 cm肾下盏结石的资料。其中fURSL 42例,钬激光碎石,较大的结石以取石网篮取出;MPCNL 43例,F 16通道,气压弹道或钬激光碎石,以涡流冲出或异物钳取出。2组术前资料差异无显著性(P>0.05)。比较2组碎石成功率及并发症。结果与MPCNL相比,fURSL一次性结石取净率低[66.7%(28/42)vs.88.4%(38/43),χ2=5.767,P=0.016],手术时间长[(47.2±4.1)min vs.(34.3±6.4)min,t=11.121,P=0.000],但术中出血少[血红蛋白下降值分别为(2.68±1.26)g/L和(5.06±1.28)g/L,t=-8.637,P=0.000],术后迟发性出血发生率低[0%(0/42)vs.14.0%(6/43),P=0.026],术后住院时间短[(3.1±1.1)d vs.(5.2±1.2)d,t=-8.292,P=0.000]。2组术后发热发生率差异无显著性(P>0.05)。结论fURSL与MPCNL均可以处理2~3 cm肾下盏结石,MPCNL的取石效率高,fURSL的创伤小、出血少。
Objective To compare the efficacy and safety of flexible ureteroscopic lithotripsy(fURSL)and miniaturized percutaneous nephrolithotomy(MPCNL)for treating subrenal calyx caculus with a diameter of 2-3 cm.Methods A total of 85 patients who underwent fURSL(n=42)or MPCNL(n=43)for subrenal calyx calculus stones with a diameter of 2-3 cm from June 2018 to April 2019 were retrospectively analyzed.In Group fURSL,a flexible ureteroscope sheath required imbedding intraoperatively.The stones were smashed by holmium laser lithotripsy by flexible ureteroscope.The relatively bigger stones were removed by the reticular basket.In Group MPCNL,the F 16 operational channel was used.The stones were smashed by pneumatic lithotripsy or holmium laser lithotripsy.Then the little smashed stones were rushed out by eddy currents or grasping forceps.The intraoperative and postoperative data including stone-free rate and complications were compared.Results Compared with MPCNL group,fURSL group showed lower one-session stone free rate(SFR)[66.7%(28/42)vs.88.4%(38/43),χ2=5.767,P=0.016]and longer operation duration[(47.2±4.1)min vs.(34.3±6.4)min,t=11.121,P=0.000],but less intraoperative decrease in hemoglobin[(2.68±1.26)g/L vs.(5.06±1.28)g/L,t=-8.637,P=0.000],lower incidence of delayed hemorrhage[0%(0/42)vs.14.0%(6/43),P=0.026]and shorter hospital stay[(3.1±1.1)d vs.(5.2±1.2)d,t=-8.292,P=0.000].The incidence of postoperative fever had no statistically significant difference between the two groups(P>0.05).Conclusions fURSL and MPCNL are both effective and safe for treating subrenal calyx caculus with a diameter of 2-3 cm.MPCNL shows more higher stone free rate.However,fURSL is associated with less trauma and less bleeding.
作者
王世先
杨水法
杨恩明
潘东山
黄旭锋
谢晓强
王俊龙
王飞
洪德时
林晓翰
杨妙莹
Wang Shixian;Yang Shuifa;Yang Enming(Department of Urology,The Affiliated Second Hospital of Xiamen Medical College,Xiamen 361021,China)
出处
《中国微创外科杂志》
CSCD
北大核心
2020年第1期35-38,共4页
Chinese Journal of Minimally Invasive Surgery
基金
厦门市科技局科技惠民项目(3502Z20189064)
关键词
肾下盏结石
输尿管软镜
微造瘘经皮肾镜
钬激光
Subrenal calyx caculus
Flexible ureterorenoscope
Miniaturized percutaneous nephrolithotomy
Holmium laser
