直径小于2cm肾结石的治疗:输尿管软镜或微通道经皮肾镜?  

The Management of Renal Stones Less than 2cm: Flexible Ureteroscopy or Mini- percutaneous Nephrolithotomy?

作　　者：张建军[1] 金讯波[1] 王滕滕[1] 

机构地区：[1]山东大学附属省立医院泌尿微创中心,山东济南250021

出　　处：《泌尿外科杂志（电子版）》2013年第4期15-18,47,共5页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的评估输尿管软镜碎石术对直径小于2cm肾结石的疗效。方法 2010年9月至2013年6月,34名肾结石直径小于2cm患者接受了输尿管软镜碎石术治疗。这些患者的治疗效果与那些接受微通道经皮肾镜碎石术的患者用配对分析方法进行比较。配对参数包括结石的大小、位置、数目,以及性别、年龄、体重指数、肾积水程度、术前是否有体外碎石史及开放手术史。应用SPSS16统计软件行统计学分析。结果输尿管软镜组一期手术后患者的无石率为82.1%,经肾皮镜组为97%。输尿管软镜组中4例患者二期接受输尿管软镜碎石术,术后3月随访总的无石率为94.1%,而经皮肾镜组为97%。输尿管软镜组38例平均手术时间为(66.5±21.6)分钟,经皮肾镜组为(38.8±9.7)分钟,总的并发症率经皮肾镜组及输尿管软镜组均为8.8%,经皮肾镜组中2例患者需输血,1例患者术后发热。输尿管软镜组3例患者术后发热。输尿管软镜组术后住院时间(60.4±18.3)小时明显短于经皮肾镜组(192.4±28.6)小时。两组中结石成分主要是草酸钙。结论输尿管软镜碎石术并发症发生率低,为肾结石大小适中的患者提供了一个安全高效的方法,与微通道经皮肾镜碎石术比,在风险、疗效、术后住院时间等方面各具优势。Objective The aim of our study was to evaluate the outcomes of flexible ureteroscopy for renal stones less than 2 cm.Methods Between September 2010 and June 2013, a total of 34 patients with renal stones that measured less than 2 cm were treated with flexible ureteroscopy .The outcomes of these patients were com-pared with those of the patients who underwent mini -percutaneous nephrolithotomy using matched -pair analy-sis (1:1 scenario).The matching prameters were the size and location of the stone as well as age , sex, body&nbsp;mass index , degree of hydronephrosis , presence of previous shockwave lithotripsy , and open surgery .SPSS ver-sion 16 was used for statistical analysis .Results Stone -free rates after a single procedure were achieved in 82 .1% of patients for flexible ureteroscopy and 97%of patients for the Mini-PCNL group .The second flexible ureterorenoscopy procedure was performed for four patients in flexible ureteroscopy group .Finally , stone-free rates during the third month of the follow -up period were 94.1%in flexible ureteroscopy group and 97%in the mini-PCNL group.The mean operative time per patient was 66.5 ± 21.6 minutes in flexible ureteroscopy group after a total of 38 procedures, while it was 38.8 ±9.7 minutes in the mini-PCNL group (P<0.0001). The overall complication rates for flexible ureteroscopy and mini -PCNL groups were 8 .8%.Blood transfusions were needed in two patients in the mini -PCNL group .Transient fever were found in three patients in flexible ureteroscopy group .Hospitalization time of postoperation was significantly shorter in the flexible ureteroscopy group(60.4 ±18.3h versus 192.4 ±28.6h;P<0.0001).In both groups, stones were most frequently com-posed of calcium oxalate .Conclusions Flexible ureteroscopy has a low complication rate and represents a safe and effective treatment alternative in selected patients with kidney stones of moderate size .

关 键 词：输尿管软镜碎石术 微通道经皮肾镜碎石术 

分 类 号：R699.2[医药卫生—泌尿科学]