输尿管软镜与微创经皮肾镜碎石术治疗2~3cm肾下盏结石的疗效对比  

Comparison of retrograde intrarenal surgery and minimally invasive percutaneous nephrolithotomy in the treatment for 2 -3 cm subrenal calyx calculus

作　　者：颜姚 王强东[1] 董振佳 袁秦波[1] 肖旭[1] 谢杰[1] Yan Yao;Wang Qiangdong;Don g Zhenjia;Yuan Qinbo;Xiao Xu;Xie Jie(Department of Urology,Huai Yin Hospital,Huai'an 223300,China)

机构地区：[1]江苏省淮安市淮阴医院泌尿外科,223300

出　　处：《国际泌尿系统杂志》2019年第1期47-50,共4页International Journal of Urology and Nephrology

摘　　要：目的比较输尿管软镜碎石术与微创经皮肾镜碎石术治疗2~3cm肾脏下盏结石的疗效。方法选取本院泌尿外科2016年7月至2017年6月符合病例入选标准的68例直径在2~3cm肾下盏结石患者为研究对象。按入院就诊先后顺序分为输尿管软镜组(34例)和微创经皮肾镜组(34例),分别采用输尿管软镜碎石术和微创经皮肾镜碎石术治疗。对两组患者一次性成功率及结石清除率、手术时间、术中出血量、术后住院天数、术后并发症、术后患者舒适度、疼痛度及创伤指标(TNF-α、IL-6和CRP)及总手术费用进行比较。结果两组患者一期手术均获得成功,两组术后1个月结石清除率比较差异无统计学意义(P>0.05);微创经皮肾镜组手术时间明显比输尿管软镜组短(P<0.05),但术中出血量及术后住院时间明显高于输尿管软镜组(P<0.05);在术后并发症发病率方面,输尿管软镜组明显低于微创经皮肾镜组(P<0.05);输尿管软镜组术后6、12、24、48h的疼痛评分明显低于微创就经皮肾镜组(P<0.05),而舒适度评分明显高于微创就经皮肾镜组(P<0.05)。在手术费用方面,输尿管软镜组明显低于微创经皮肾镜组(P<0.05)。两组患者术后血清TNF-α、IL-6及CRP24h后均升高,但72h后下降。不同时间点经皮肾镜组明显高于输尿管软镜组(P<0.05)。结论对于直径2~3cm的肾下盏结石,输尿管软镜在结石清除率上接近于微创经皮肾镜,并具有出血少、创伤小、费用低、较高的舒适度、较低的并发症发生率及术后恢复快等优势,是治疗的一种可靠选择,其有望成为治疗2~3cm肾脏下盏结石的主要手术方式之一。Objective To compare the therapeutic effect of retrograde intrarenal surgery and minimally invasive percutaneous nephrolithotomy for the treatment of 2-3 cm subrenal calyx calculus. Methods From July 2016 to June 2017, 68 patients were randomly divided into retrograde intrarenal surgery group (34 cases) and minimally invasive percutaneous nephrolithotomy group (34 cases). They were treated by retrograde intrarenal surgery and minimally invasive percutaneous nephrolithotomy. The one-time success rate and stone clearance rate, operative time, intraoperative blood loss, postoperative hospitalization days, postoperative complications, postoperative comfort, pain and trauma indicators (TNF-alpha, IL-6 and CRP) and total operative cost of the two groups were compared. Results The two groups of patients were successful in the first stage operation. There was no significant difference in the stone clearance rate between the two groups 1 month after operation. Operation time of minimally invasive percutaneous nephroscope group was less than retrograde intrarenal surgery group. The amount of intraoperative bleeding and the time of postoperative hospitalization were significantly higher than that of the retrograde intrarenal surgery group. However, intraoperative blood loss and postoperative hospitalization time were significantly higher than those in retrograde intrarenal surgery group. The postoperative pain scores of 6, 12, 24 and 48 h were significantly lower than those of minimally invasive percutaneous nephrolithotomy group, while comfort score was significantly higher than that of minimally invasive percutaneous nephrolithotomy group. In the operation cost, the retrograde intrarenal surgery group was significantly lower than the minimally invasive percutaneous nephroscope. The serum TNF- alpha, IL-6 and CRP increased 24 hours after operation in the two groups, but decreased after 72 hours. There was significant difference between the two groups at different time points. Conclusions For the lower calyx diameter 2-3 cm

关 键 词：肾结石 输尿管镜检查 肾造口术 经皮 

分 类 号：R699.2[医药卫生—泌尿科学]