摘要
目的比较斜仰卧截石位下Ⅰ期超微通道经皮肾镜(SMP)联合输尿管软镜(FURL)与单纯FURL治疗2.0~3.0 cm肾结石的疗效,探讨斜仰卧截石位下双镜联合(SMP联合FURL)治疗2.0~3.0 cm肾结石的有效性及安全性。方法回顾性分析2018年1月—2021年5月苏州大学附属常熟医院收治的2.0~3.0 cm肾结石患者55例,其中47例为复杂性肾结石。所有患者中,肾盂漏斗部夹角≤30°的肾下盏结石14例。23例采用双镜联合(SMP联合FURL)治疗(双镜联合组),32例行FURL治疗(FURL组)。对两组手术时间、血红蛋白下降值、术后住院时间、住院费用、结石清除率和并发症发生情况等进行比较分析。结果两组手术均顺利完成。双镜联合组平均血红蛋白下降值[(16.30±10.17)g/L]、术后住院时间[(5.35±1.61)d]、住院费用[(22481±2234)元]均高于FURL组[(6.94±6.61)g/L、(3.19±1.26)d、(18209±2584)元],差异有统计学意义(P<0.05);而两组手术时间[(79.57±8.52)min vs.(79.22±3.83)min]差异无统计学意义(P>0.05)。术后1个月复查CT,双镜联合组结石清除率显著高于FURL组(91.30%vs.65.63%,P=0.027)。而两组患者的总并发症发生率(21.74%vs.21.88%)差异无统计学意义(P>0.05)。双镜联合组接受再治疗1例(4.35%),FURL组接受再治疗5例(15.63%),差异无统计学意义(P>0.05)。结论斜仰卧截石位下超微通道经皮肾镜联合输尿管软镜治疗2.0~3.0 cm肾结石具有结石一期清除率高、且与FURL相比不增加并发症发生风险的优点。
Objective To compare the clinical safety and effectiveness of super-mini-percutaneous nephroscope(SMP)combined with flexible ureteroscopic lithotripsy(FURL)in oblique supine lithotomy position and FURL alone in the treatment of 2.0-3.0 cm renal calculi.Methods Clinical data of 55 patients treated during Jan.2018 and May 2021 were retrospectively analyzed,including 47 cases complicated renal calculi,and 14 cases of lower calyceal calculi with infundibulopelvic angle≤30°.SMP combined with FURL was performed in 23 cases(combined group),and FURL alone was performed in 32 cases(FURL group).The operation time,hemoglobin reduction,postoperative hospital stay,hospitalization expenses,stone-clearance rate and complications were compared.Results All operations were successful.Compared with the FRUL group,the combined group had significantly more hemoglobin reduction[(16.30±10.17)g/L vs.(6.94±6.61)g/L],longer postoperative hospital stay[(5.35±1.61)d vs.(3.19±1.26)d],and higher hospitalization expenses[(22481±2234)yuan vs.(18209±2584)yuan](P<0.05).However,there was no significant difference in operation time[(79.57±8.52)min vs.(79.22±3.83 min),P>0.05].One month after surgery,CT results showed that the combined group had higher stone-clearance rate(91.30%vs.65.63%,P=0.027).There was no difference in the complication rate(21.74%vs.21.88%,P>0.05).One case(4.35%)in the combined group and 5 cases(15.63%)in the FURL group received retreatment(P>0.05).Conclusion SMP combined with FURL in oblique supine lithotomy position is safe and effective in the treatment of 2.0-3.0 cm renal calculi,with high stone-clearance rate and low complication rate.
作者
丁琪
范波
朱海亮
范志江
李锋
屠文健
金晓华
DING Qi;FAN Bo;ZHU Hailiang;FAN Zhijiang;LI Feng;TU Wenjian;JIN Xiaohua(Department of Urology,Changshu Hospital Affiliated to Soochow University,Changshu No.1 People's Hospital,Changshu 215500,China)
出处
《现代泌尿外科杂志》
CAS
2023年第9期759-763,共5页
Journal of Modern Urology
基金
苏州市临床重点病种诊疗技术专项项目(No.LCZX201921)
苏州市产业技术创新专项项目(No.SYSD2017017)
常熟市科技发展计划项目(No.CR201712)
常熟市临床医学专家团队引进项目(No.CSYJTD202001)
常熟市医学重点学科项目(No.CSZDXK202001)。
关键词
复杂性肾结石
双镜联合
斜仰卧截石位
超微通道经皮肾镜
输尿管软镜
complicated renal calculi
combined endoscopes
oblique supine lithotomy position
super-mini-percutaneous nephroscope
flexible ureteroscope
