分层分析比较超微经皮肾镜与输尿管软镜治疗1.5~2.5 cm肾结石的临床观察  

Super-mini percutaneous nephrolithotomy versus flexible ureteroscopy lithotripsy for 1.5-2.5 cm kidney stones:a layered analysis based on stone sizes

作　　者：陈科梁 鲁佩[2] 张炜[2] 宋日进[2] 亓凯 张中攀 郑一春 黄光毅 CHEN Ke-liang;LU Pei;ZHANG Wei;SONG Ri-jin;QI Kai;ZHANG Zhong-pan;ZHENG YI-chun;HUANG Guang-yi(Department of Urology,The Fourth Affiliated Hospital,School of Medicine,Zhejiang University,Yiwu 322000;Department of Urology,The First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]浙江大学医学院附属第四医院泌尿外科,浙江义乌322000 [2]南京医科大学第一附属医院泌尿外科,江苏南京210029

出　　处：《现代泌尿外科杂志》2020年第12期1069-1074,共6页Journal of Modern Urology

摘　　要：目的根据肾结石大小分层分析比较超微经皮肾镜碎石取石术(SMP)与输尿管软镜碎石取石术(FURL)的疗效。方法回顾性分析2017年2月至2019年5月浙江大学医学院附属第四医院收治的160例肾结石患者,按照术式分为SMP组和FURL组,每组根据结石最大径分为2个层面:1.5~<2.0cm结石,SMP及FURL组各30例;2.0~2.5cm结石,SMP及FURL组各50例。结果 1.5~<2.0cm结石:FURL组的平均血红蛋白(HGB)下降水平显著低于SMP组(P=0.007)。SMP组的术后即时结石清除率(SFR)和术后1个月SFR,与FURL组相比差异无统计学意义。SMP组手术费用显著低于FURL组(P<0.001)。2.0~2.5cm肾结石:SMP组的手术时间明显较FURL组短(P=0.042),FURL组的平均HGB下降水平显著低于SMP组(P=0.015)。SMP组的术后即时和术后1个月SFR均高于FURL组(P=0.003、P=0.037)。SMP组手术费用显著低于FURL组(P<0.001)。结论治疗1.5~<2.0cm肾结石,从微创方面考虑优先选择FURL;而从手术费用方面考虑首选SMP。对于2.0~2.5cm肾结石,SMP组的SFR及手术性价比较FURL更佳,建议选择SMP。Objective To compare the efficacy of super-mini percutaneous nephrolithotomy(SMP)and flexible ureteroscopy lithotripsy(FURL)in the treatment of kidney stones.Methods The clinical data of 160 nephrolithiasis patients treated during Feb.2017 and May 2019 were retrospectively analyzed,including the SMP group(n=80)and FURL group(n=80).According to the maximum stone diameter,the two groups were subdivided into 1.5-<2.0 cm subgroups(n=30)and 2.0-2.5 cm subgroups(n=50),respectively.Results For the 1.5-<2.0 cm stones:the FURL subgroup showed less hemoglobin reduction than the SMP subgroup(P=0.007);there were no significant differences in the stone-free rate(SFR)immediately after operation and SFR 1 month after operation;the SMP subgroup had fewer surgery costs than the FURL subgroup(P<0.001).For the 2.0-2.5 cm stones:the FURL subgroup had shorter operation time than the SMP subgroup(P=0.042);the SMP subgroup had less hemoglobin reduction than the FURL subgroup(P=0.015);the SMP subgroup had higher SFR immediately after operation and SFR 1 month after operation than the FURL subgroup(P=0.003,P=0.037);the SMP subgroup had fewer surgery costs than the FURL subgroup(P<0.001).Conclusion For patients with kidney stones of 1.5-<2.0 cm,in terms of operative trauma,FURL is recommended,while in terms of costs,SMP is more economical.For patients with stones of 2.0-2.5 cm,SMP is recommended as it has higher SFR and cost performance.

关 键 词：肾结石 超微经皮肾镜碎石取石术 输尿管软镜碎石取石术 分层分析 结石清除率 

分 类 号：R692.4[医药卫生—泌尿科学]