微创经皮肾镜与输尿管软镜治疗2～4cm肾下盏结石的比较  

Comparative analysis of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery in management of lower pole renal stones(2～4cm)

作　　者：张宇 李九智[2] 姜有涛[2] 张国飞[3] 吴越[3] Zhang Yu;Li Jiuzhi;Jiang Youtao;Zhang Guofei;Wu Yue(Department of Urology, Bao＇an Central Hospital of Shen Zhen, Guangdong 518102, China;People＇s Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830011, China;Department of Urology, the Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830000, China)

机构地区：[1]深圳市宝安区中心医院泌尿外科,518102 [2]新疆维吾尔自治区人民医院泌尿外科中心,乌鲁木齐830011 [3]新疆医科大学第六附属医院泌尿外科,乌鲁木齐830000

出　　处：《中华腔镜泌尿外科杂志（电子版）》2018年第2期111-115,共5页Chinese Journal of Endourology(Electronic Edition)

基　　金：深圳市宝安区医疗卫生科研项目(2016CX049)

摘　　要：目的比较微创经皮肾镜碎石取石术(MPCNL)和输尿管软镜碎石术(RIRS)治疗2~4 cm肾下盏结石的效果。方法我们回顾性分析新疆医科大学第六附属医院、深圳市宝安区中心医院和新疆自治区人民医院三家医院从2011年6月至2016年6月治疗直径范围2~4 cm肾下盏结石167例病例资料,根据手术方式不同分为两组:MPCNL 98例,RIRS 69例。结果 MPCNL组手术时间(84±28)min,短于RIRS组(116±23)min(P<0.001);MPCNL术中血红蛋白下降值(5.2±1.6)g/L,明显高于RIRS组(1.9±0.4)g/L(P<0.001);住院时间(8.5±1.4)d,明显长于RIRS组(3.8±1.2)d(P<0.001);术后并发症率MPCNL组14.3%(14/98)高于RIRS组4.3%(3/69)(P=0.036);MPCNL一期清石率87.8%(86/98)高于RIRS组55.1%(38/69)(P<0.001);总清石率分别为93.9%(92/98)和91.3%(63/69),两者接近(P=0.506)。结论 MPCNL是治疗2~4 cm肾下盏结石的有效手段,但为了更加微创、出血更少、住院时间更短,RIRS在一定程度上可以作为治疗肾下盏结石的一种有效的替代手术方式。Objective To compare the efficacy of MPCNL and RIRS in lower pole renal stones 2-4 cm in diameter. Methods A total of 167 patients who underwent MPCNL or RIRS for lower pole stone 2-4 cm in diameter between June 2011 and June 2016 were retrospectively analyzed. Lower pole stone was diagnosed with CT scan. Stone size was assessed as the longest axis of the stone. All patients were informed about the advantages, disadvantages and probable complications of both MPCNL and RIRS before the selection of the procedure. Patients were divided into two groups according to the patients＇ surgery type. Group 1 consisted of 98 patients who underwent MPCNL and Group 2 consisted of 69 patients treated with RIRS. Stone free statuses, postoperative complications,operative time and hospitalization time were compared in both groups. Results The mean operation time was （84±28） min vs （116 ±23） rain（P〈0.001）; The mean hemoglobin drop value was （5.2±1.6） g/L vs （1.9±0.4） g/L （P〈0.001）; The postoperative hospital stay was （8.5 ± 1.4） d for MPCNL, which was longer than that of the RIRS group （3.8 ±1.2） d （P〈0.001）. The respective complication rates were 14.3% （14/98） and 4.3%（3/69） （P=0.036）. In MPCNL group, stone-free rate was 87.8% （86/98） at first session and 93.9% （92/98） after the additional procedure. In RIRS group,stone-free rate was 55.1%（38/69） at the first procedure and 91.3%（63/69） after the additional procedure. The final stone-free rates were similar in both groups （P=0.506）. Conclusions MPCNL is an effective method for the treatment of lower pole stones 2-4 cm in diameter. RIRS should be an effective treatment alternative to MPCNL in lower pole stones, especially in selected patients.

关 键 词：肾结石 下盏 经皮肾镜 输尿管镜 

分 类 号：R699.2[医药卫生—泌尿科学]