逆行肾内手术与经皮肾镜取石术治疗嵌顿性输尿管上段结石的疗效比较  

Safety and efficacy of retrograde intrarenal surgery and percutaneous nephrolithotomy in the treatment of incarcerated upper ureteral calculi

作　　者：张履文 宋彦[1] 费翔[1] Zhang Lyuwen;Song Yan;Fei Xiang(Department of Urology,Shengjing Hospital Affiliated to China Medical University,Shenyang 110000,China)

机构地区：[1]中国医科大学附属盛京医院泌尿外科,沈阳110000

出　　处：《中华泌尿外科杂志》2021年第7期518-523,共6页Chinese Journal of Urology

摘　　要：目的比较逆行肾内手术(RIRS)与经皮肾镜取石术(PCNL)治疗嵌顿性输尿管上段结石的疗效。方法回顾性分析2018年1月至2020年4月中国医科大学附属盛京医院收治的202例嵌顿性输尿管上段结石患者的临床资料,其中140例行RIRS治疗,为RIRS组;62例行PCNL治疗,为PCNL组。两组患者年龄[(54.40±11.17)岁与(52.82±12.58)岁]、性别[男/女:86/54例与45/17例]、体质指数[24.0(21.0,27.0)kg/m^(2)与23.5(20.8,26.3)kg/m^(2)]、肌酐[75.5(61.6,93.3)μmol/L与73.7(62.4,93.0)μmol/L]、结石存在时间[1.0(0.5,3.8)个月与1.0(0.5,6.0)个月]、结石硬度[(783.60±243.55)HU与(960.66±225.01)HU]、结石直径[(8.65±2.95)mm与(10.15±2.94)mm]、结石位置(左/右:65/75例与34/28例)、术前感染比例(40/140例与25/62例)及既往体外冲击波碎石治疗比例(35/140例与13/62例)差异均无统计学意义(P>0.05)。比较两组手术时间、住院时间、围手术期并发症、住院费用、结石清除率等。进一步根据影响结石清除的高危因素(结石直径>2 cm、结石硬度>1000HU、既往有碎石术史、结石嵌顿时间>6个月、肾积水程度≥中度、存在感染)进行赋分(是=1分,否=0分),复杂结石定义为≥3分,单纯结石定义为<3分。根据结石复杂程度进行亚组分析,比较各组围手术期相关指标。结果202例手术均顺利完成,无中转开放手术或其他手术方式。PCNL组较RIRS组手术时间明显缩短[48.5(32.0,62.5)min与63.0(48.0,86.0)min,P<0.05],结石清除率显著提高[98.4%(61/62)与72.1%(101/140),P<0.05],住院费用更低[1.16(0.80,1.40)万元与2.73(2.14,3.32)万元,P<0.05]。RIRS组较PCNL组住院时间更短[3.0(2.0,4.0)d与8.0(6.0,9.0)d,P<0.05];两组术后并发症差异无统计学意义[10.7%(15/140)与12.9%(8/62),P>0.05]。对于单纯结石患者,PCNL组较RIRS组手术时间更短[50.0(30.0,64.0)min与62.0(44.5,86.0)min,P<0.05],住院费用更低[1.18(0.80,1.35)万元与2.69(2.22,3.32)万元,P<0.05],结石清除率更高[100.0%(35/3Objective To compare the clinical efficacy of retrograde intrarenal surgery(RIRS)and percutaneous nephrolithotomy(PCNL)in the treatment of incarcerated upper ureteral calculi.Methods The clinical data of 202 patients with incarcerated upper ureteral calculi treated in our hospital from January 2018 to April 2020 were analyzed retrospectively,including RIRS group treated with RIRS and PCNL group treated with PCNL.There was no significant difference in age[(54.40±11.17)years vs.(52.82±12.58)years],sex[male/female:86/54 vs.45/17],body mass index[24.0(21.0,27.0)kg/m^(2) vs.23.5(20.8,26.3)kg/m^(2)],creatinine[75.45(61.6,93.3)μmol/L vs.73.70(62.4,93.0)μmol/L],stone stay time[1.0(0.5,3.8)months vs.1.0(0.5,6.0)months],stone hardness[(783.60±243.55)HU vs.(960.66±225.01)HU],stone diameter[(8.65±2.95)mm vs.(960.66±225.01)mm],stone location(65/75 vs.34/28),proportion of infection before operation(40/140 vs.25/62)and history of ESWL treatment(35/140 vs.13/62)between the two groups.The operation time,hospital stay,perioperative complication rate,hospitalization cost and stone clearance rate were compared between the two groups.The high risk factors of preoperative stone characteristics(stone diameter,stone hardness,previous lithotripsy history,stone incarceration time,degree of hydronephrosis,infection)were scored(yes=1,no=0).Cases of complex stones were defined as≥3 points.Simple stone cases were defined as<3 points.Group analysis was carried out according to the score of stones in order to determine the influence of the choice of surgical methods on the results of operation.Results All 202 operations were successfully done,and there was no transfer to open surgery or other surgical methods.Compared with the RIRS group,the operation time of the PCNL group was significantly shorter[48.5(32.0,62.5)min vs.63.0(48.0,86.0)min,P<0.05],and the stone removal rate was significantly increased[98.4%(61/62)vs.72.10%(101/140),P<0.05],the treatment cost was lower[1.16(0.80,1.40)ten thousand yuan vs.2.73(2.14,3.32)ten thousand yua

关 键 词：结石 输尿管 逆行肾内手术 经皮肾镜取石术 疗效 

分 类 号：R699.4[医药卫生—泌尿科学]