MPCNL与FURL治疗肾实质厚度>2.5cm的2～3cm肾结石的疗效对比  

Comparison of the efficacy and safety between mini-percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy in management of 2-3cm kidney stones in renal parenchyma thickness greater than 2.5cm

作　　者：刘百川[1] 张福霖 钟瑞伦[1] 邱晓拂[1] 李高远[1] 王炳卫[1] 罗友华[1] 杨国胜[1] LIU Baichuan;ZHANG Fulin;ZHONG Ruilun;QIU Xiaofu;LI Gaoyuan;WANG Bingwei;LUO Youhua;YANG Guosheng(Department of Urology,Guangdong Second Provincial General Hospital,Guangzhou,510317,China)

机构地区：[1]广东省第二人民医院泌尿外科,广州510317

出　　处：《临床泌尿外科杂志》2018年第7期537-541,共5页Journal of Clinical Urology

基　　金：广东省医学科学技术研究基金项目(编号A2015195)

摘　　要：目的:探究微通道经皮肾镜取石术(mini-percutaneous nephrolithotomy,MPCNL)与输尿管软镜碎石术(flexible ureteroscopic lithotripsy,FURL)治疗肾实质厚度>2.5cm的2~3cm肾结石的有效性和安全性。方法:回顾性分析我院2015年6月~2017年6月178例肾实质厚度>2.5cm的2~3cm肾结石患者的临床资料,根据技术特点分为两组,行MPCNL患者95例为MPCNL组,行FURL患者83例为FURL组。观察178例患者的临床疗效。结果:所有手术均顺利完成。FURL组一期清石率稍低于MPCNL组(91.6%vs.94.5%),两组二期清石率比较(98.8%vs.100%),差异无统计学意义。FURL组与MPCNL组手术时间分别为(67.6±10.7)min和(51.6±8.8)min,术中出血量分别为(7.6±3.2)ml和(62.5±18.3)ml,术后第1天Hb下降值分别为(2.1±0.9)g/L和(15.0±4.4)g/L,术后住院时间分别为(63.3±28.3)h和(154.3±21.3)h,两组比较差异均有统计学意义(P<0.05)。本研究根据Clavien-Dindo外科手术并发症分级,FURL组与MPCNL组并发症发生率比较差异无统计学意义(14.5%vs.20.0%,P>0.05)。术后1个月复查腹部平片,两组患者均未见结石残留。结论:在治疗肾实质厚度>2.5cm的2~3cm肾结石患者,MPCNL与FURL均为有效方法,相比于MPCNL,FURL创伤更少、恢复快、住院时间短,推荐使用。Objective： To investigate the efficacy and safety between mini-percutaneous nephrolithotomy （MPCNL） and flexible ureteroscopic [ithotripsy （FURL） in management of 2-3 cm kidney stones in renal paren-chyma thickness greater than 2.5 cm. Method： We retrospectively analyzed the clinical data of 178 cases with 2-3 cm kidney stones and renal parenchyma thickness 〉2.5 cm in our hospital from June 2015 to June 2017. Accord- ing to the technical characteristics, the clinical data were divided into two groups, 83 cases in group FURL and 95 cases in group MPCNL. The clinical effects of 178 patients were observed. Result： All surgeries were completed successfully. The rate of one-stage lithotripsy of the Group FURL was lower than that of Group MPCNL （91.6 vs. 94.5%）, but the rate of two-stage lithotripsy between the two groups （98.8% vs. 100%） showed no significant difference. The operation time, the amount of hemorrhage during operation, the hemoglobin decline of the first postoperative day, the postoperative hospital stay of the Group FURL and Group MPCNL were （67.6±10.7） minvs. （51.6±8.8） min, （7.6±3.2） mlvs. （62.5±18.3） ml, （2.1±0.9） g/Lvs. （15.0±4.4） g/L, （63.3±28.3） h vs. （154.3±21.3） h, which there were statistical differences between the two groups （P 0.05）. According to the Clavien-Dindo grading system, there was no significant difference in complication rate between Group FURL and Group MPCNL （14.5% vs. 20.0%, P〉0.05）. One month postoperatively, the abdominal plain film was reviewed and no residual stones were found in both groups. Conclusion： In the treatment of renal calculi of 2~3 cm in renal parenchyma thickness 〉2.5 cm, both MPCNL and FURL are effective. Compared to MPCNL, FURL has the advantages of less trauma, faster recovery and shorter hospital stay, so it should be recommended.

关 键 词：输尿管软镜碎石术 经皮肾镜取石术 肾结石 肾实质 

分 类 号：R692.4[医药卫生—泌尿科学]