摘要
目的比较体外冲击波碎石术(ESWL)治疗直径1~2 cm肾上盏结石无效后行输尿管软镜碎石术(FURL)或经皮肾镜碎石术(PCNL)的临床治疗效果以及住院周期和住院费用的差异性。方法回顾性分析2017年1月—2021年11月就诊于徐州医科大学附属医院的101例ESWL治疗无效的肾上盏结石患者,结石直径大小为1~2 cm。根据手术方式的不同将患者分为FURL组(n=48)和PCNL组(n=53),对比2组患者术中出血量、手术时间、术后住院时间、住院费用,术前和术后1 d的炎症指标,术后6 h、24 h的疼痛视觉模拟评分(VAS),术后并发症情况以及术后1个月、术后3个月的结石清除率。结果与PCNL组相比,FURL组术中出血量更少,术后住院时间更短,术后6 h、24 h的VAS评分以及术后并发症发生率更低(P<0.05);与FURL组相比,PCNL组手术时间更短,住院费用更低(P<0.05);2组术后1 d外周血白细胞计数(WBC)、中性粒细胞和淋巴细胞比值(NLR)、C-反应蛋白(CRP)水平均升高(P<0.01),但FURL组术后WBC、NLR和CRP水平显著低于PCNL组(P<0.01);2组术后1个月、术后3个月结石清除率比较差异均无统计学意义(P>0.05)。结论直径1~2 cm肾上盏结石患者ESWL治疗失败后,选择FURL或PCNL均能有效清除结石。但FURL出血量少、住院周期短、疼痛轻微、术后并发症少,且能减轻患者术后炎症反应;而PCNL手术时间短,总体住院费用低,临床中患者可根据自身情况合理选择手术方案。
Objective To compare the clinical efficacy,duration of hospitalization and hospitalization cost of flexible ureteroscopic lithotripsy(FURL)or percutaneous nephrolithotripsy(PCNL)after extracorporeal shock wave lithotripsy(ESWL)for the treatment of upper calyx calculi with a diameter of 1~2 cm.Methods A retrospective analysis was performed on 101 patients with renal upper calyx calculi who failed to respond to ESWL treatment in Affiliated Hospital of Xuzhou Medical University from January 2017 to November 2021.The calculi diameter was 1~2 cm.Patients were divided into FURL group(n=48)and PCNL group(n=53)according to different surgical methods.Intraoperative blood loss,operation time,postoperative hospital stay,hospitalization cost,preoperative and postoperative inflammatory indicators 1 day,postoperative visual analogue score(VAS)of 6 h and 24 h,postoperative complications,and stone clearance rate 1 month and 3 months after surgery were compared between the two groups.Results Compared with PCNL group,FURL group had less intraoperative blood loss,shorter postoperative hospital stay,lower incidence of postoperative complications,and lower VAS at 6 and 24 hours after surgery(P<0.05).Compared with FURL group,PCNL group had shorter operation time and lower hospitalization cost(P<0.05).Peripheral blood white blood cell count(WBC),neutrophil to lymphocyte ratio(NLR)and C-reactive protein(CRP)levels were all increased 1 day after surgery in both groups(P<0.01),but the levels of WBC,NLR and CRP in FURL group were significantly lower than those in PCNL group(P<0.01).There was no significant difference in stone clearance rates 1 and 3 months after surgery between the two groups(P>0.05).Conclusions After ESWL treatment failed in patients with 1~2 cm diameter upper calyx calculi,both FURL and PCNL can effectively remove stones.The difference lies in that FURL has little blood loss,short hospitalization period,mild pain and few postoperative complications,and reduces postoperative inflammation,while PCNL has short operation tim
作者
徐鑫
许阳
陈仁富
XU Xin;XU Yang;CHEN Renfu(Department of Urology,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China;Graduate School,Xuzhou Medical University,Xuzhou,Jiangsu 221004;Department of Urology,Huzhou Hospital Affiliated to Zhejiang University School of Medicine,Huzhou,Zhejiang 313099)
出处
《徐州医科大学学报》
CAS
2023年第4期253-257,共5页
Journal of Xuzhou Medical University
关键词
肾上盏结石
体外冲击波碎石术
输尿管软镜碎石术
经皮肾镜碎石术
疗效
炎症指标
upper calyx calculi
extracorporeal shock wave lithotripsy
flexible ureteroscopic lithotripsy
percutaneous nephrolithotomy
prognosis
inflammatory index
