输尿管软镜联合硬镜与微创经皮肾镜治疗复杂性输尿管上段结石应用比较  

Comparison between flexible ureteroscope combined with rigid ureteroscope and minimal percutaneous nephrolithotomy for treatment of complicated upper ureteral calculi

作　　者：林天旗 许振强 林海利 庄志明 张朝贤 LIN Tianqi;XU Zhenqiang;LIN Haili;ZHUANG Zhiming;ZHANG Chaoxian.(Department of Urology, Affiliated Zhangzhou City Hospital of Fujian Medical University, Zhangzhou, Fujian, 363000, Chin)

机构地区：[1]福建医科大学附属漳州市医院泌尿外科,福建漳州363000

出　　处：《临床泌尿外科杂志》2018年第3期235-237,241,共4页Journal of Clinical Urology

摘　　要：目的:比较应用输尿管软镜联合硬镜(flexible ureteroscope combined with rigid ureteroscope,FRURS)与微创经皮肾镜(minimal invasive percutaneous nephrolithotomy,mPCNL)治疗复杂性输尿管上段结石的临床疗效。方法:选取2014年8月~2016年9月我院收治复杂性输尿管上段结石患者87例,依手术方式的不同,将入组对象随机分为观察组(45例)及对照组(42例)。观察组接受F-RURS治疗,对照组接受mPCNL治疗,比较两组手术时间、手术前后血红蛋白变化、一期碎石成功率、住院时间、术后感染率、术后1个月及3个月的结石清除率。结果:观察组患者手术前后血红蛋白变化明显少于对照组[(8.42±4.32)g/L vs.(21.50±9.38)g/L,P<0.05],住院时间明显短于对照组[(4.5±1.5)d vs.(8.5±2.5)d,P<0.05],手术时间长于对照组[(65.1±10.9)min vs.(48.7±9.5)min,P<0.05],术后1个月结石清除率低于对照组(68.89%vs.97.61%,P<0.05)。观察组与对照组比较,一期碎石成功率(95.56%vs.100.00%)、术后3个月结石清除率(93.33%vs.100.00%)、术后感染率(6.67%vs.4.76%)差异均无统计学意义(P>0.05)。结论:F-RURS与mPCNL是复杂性输尿管上段结石的有效治疗方法,F-RURS完全经自然腔道碎石,出血更少,住院时间更短。Objective： To compare the curative effect between flexible ureteroscope combined with rigid uret- eroscope （F-RURS） and minimal percutaneous nephrolithotomy （mPCNL） for treatment of complicated upper ure- term calculi. Method： From August 2014 to September 2016, 87 patients were diagnosed as complicated upper u- reteral calculi. According to the different surgical methods, included subjects were randomly divided into two groups, 45 cases of observation group and 42 cases of control group. The observation group received F-RURS and the control group received mPCNL. The operative time, the difference of hemoglobin before and after surgery, one-session successful rate of lithotripsy, length of hospital stay, postoperative infection rate, one-month and three-month stone-free rate were compared between the groups. Result： The observation group had significantly less hemoglobin difference before and after surgery, shorter hospital stay and lower one-month stone-free rate than those in the control group, and the difference was statistical [（8. 42±4. 32） g/L vs. （21.50±9.38） g/L; （4.5±1.5） d vs. （8.5±2.5） d; 68.89% vs. 97.61%; P〈0.05]. However, there was no significant difference and no statistical significance of the one-session successful rate of lithotripsy, three-month stone-free rate and postopera- tive infection rate between the observation group and the control group [-95.56% vs. 100.00%; 93.33% vs. 100. 00%; 6. 67% vs. 4.76%; P〉0. 05]. Conclusion： Both F-RURS and mPCNL are effective means for the treatment of complicated upper ureteral calculi. F-RURS has the advantages including short hospital stay and less blood loss in operation fully through a natural ureteral cavity.

关 键 词：输尿管软镜联合硬镜 微创经皮肾镜 复杂性输尿管上段结石 

分 类 号：R693[医药卫生—泌尿科学]