输尿管软镜碎石术和微创经皮肾镜碎石术治疗直径2～4cm上尿路结石的疗效比较  

Comparative efficacy of flexible ureteroscopic lithotripsy and mini - percutaneous nephrolithotomy for 2 - 4 cm renal calculi

作　　者：耿和[1] 施华娟[1] 吴宗林[1] 朱洪炜[1] 唐炯[1] 张涛[1] 刘翔[1] 

机构地区：[1]上海市普陀区人民医院泌尿外科,上海200060

出　　处：《国际泌尿系统杂志》2018年第1期75-79,共5页International Journal of Urology and Nephrology

摘　　要：目的比较微创经皮肾镜碎石术（mini—pereutaneous nephrolithotomy，MPCNL）与输尿管软镜碎石术（flexible ureteroseope，FUSL）治疗2～4cm肾结石的临床效果。方法回顾性分析2012年6月至2016年6月期间本院收治的患直径2—4cm肾结石65例的患者，其中MPCNL31例，FUSL34例，比较两者结石清除率（stone free rate，SFR）、手术时间、住院时间及并发症。结果MPCNL组和FURS组的SFR分别为90．3％（28／31）和79．4％（27／34），两组比较差异没有统计学意义（P〉0．05）。MPCNL组和FUSL组手术时间分别为（66．8±25．3）min和（103．8±33．5）min，差异有统计学意义（P〈0．01），术后住院天数分别为（6．5±1．6）d和（3．2±1．3）d，差异有统计学意义（P〈0．01）。MPCNL组术后感染性休克2例，出血1例，尿外渗1例，3周后肾自发性破裂出血1例；FUSL组术后发热1例，均抗感染对症支持治疗后缓解。MPCNL组术后并发症发生率（5／31）较高，但两组术后并发症比较差异无统计学意义（P〉0．05）。结论MPCNL与FUSL均是治疗2～4cm肾结石的有效治疗方法。FUSL具有微创、并发症发生率低、恢复快等优点，值得I临床推广应用。Objective To compare the therapeutic effects of mini - pereutaneous nephrolithotomy（MPCNL） and flexible ureteroscope（FUSL） in the treatment of 2 - 4 cm renal calculi. Methods The data of 65 patients with 2 N 4 cm renal calculi between June 2012 and June 2016 were retrospectively reviewed. Of which, 31 patients underwent MPCNL and 34 patients underwent FUSL. The operative time, the postoperative hospitalization time, the stone free rate and the complications were compared between the two kinds of surgical procedures. Results Stone free rates after one session were 90.3% （28/31） for MPCNL and 79.4% （27/34） for FUSL, and the differences were not statistically significant（ P 〉 0. 05 ）. The operative time was （66.8 ± 25.3 ） min and （ 103.8 ±33.5 ） rain in the MPCNL and FUSL group, respectively（ P 〈 0. 01 ）, and postoperative hospitalization time was （6. 5 ± 1.6） days and （3.2 ± 1.3 ） days in two groups, respectively（P 〈 0. 01 ）. The main complications included 2 cases of septic shock, 1 case of bleeding, 1 case of urinary extravasation and 1 case of renal spontaneous rupture bleeding after 3 weeks in the MPCNL group and 1 case of fever in the FUSL group. Overall complication rates in the MPCNL group were higher, but the differences were not statistically significant between the two groups （ P 〉 0.05 ）. Conclusions Both MPCNL and FUSL are efficacy and safe surgical operation for patients with 2 -4 cm renal calculi. As to the FUSL, its merits are less invasiveness, lower complication rate and faster recovery, and worthy of clinical application.

关 键 词：尿路结石 碎石术 输尿管镜 肾造口术 经皮 

分 类 号：R699[医药卫生—泌尿科学]