输尿管软镜与经皮肾镜治疗有经皮肾镜手术史的复杂性结石的比较  

Comparison of retrograde intrarenal surgery and percutaneous nephroscopy in the treatment of complex renal calculi with a history of previous percutaneous nephroscopy

作　　者：吴骏超 和术臣[1] 王海峰 王家平[1] 邱学德[1] Wu Junchao;He Shuchen;Wang Haifeng;Wang Jiaping;Qiu Xuede(Department of Urology,the Second Affiliated Hospital of Kunming Medical University,Yunnan 650032,China)

机构地区：[1]昆明医科大学附属第二医院泌尿外科,云南650032

出　　处：《中华腔镜泌尿外科杂志（电子版）》2023年第3期233-236,共4页Chinese Journal of Endourology(Electronic Edition)

基　　金：昆明医科大学研究生创新基金(2022S260)。

摘　　要：目的探讨患者既往有经皮肾镜碎石取石术(PCNL)史,后二次手术行PCNL或输尿管软镜碎石取石术(RIRS)治疗复杂性肾结石的安全性及疗效。方法回顾性分析2017年1月至2022年5月昆明医科大学第二附属医院收治的既往有PCNL手术史的76例PCNL及83例RIRS患者的临床资料,比较两组术中出血、术前泌尿道感染、结石清除率、手术时间、住院时间、住院费用及术后并发症的差异。结果PCNL组及RIRS组在年龄、性别、体质量指数、结石最大径、结石类型、泌尿系感染率等差异无统计学意义(P>0.05)。术中PCNL组血红蛋白损失量(23±11)g/L,RIRS组(16±7)g/L;术中红细胞压积损失量分别为(6.4±3.0)%和(4.5±2.1)%;手术时间分别为(155±39)min和(118±33)min;结石清除率分别为64.5%和79.5%,平均住院时间分别为(7.0±2.2)d和(5.6±1.5)d,治疗费用分别为(13978±3487)元和(19783±7239)元,差异均有统计学意义(P<0.05)。两组术后并发症差异无统计学意义(P>0.05)。结论对于既往有PCNL手术史的复杂性肾结石患者,二次手术行RIRS疗效优于PCNL,但治疗费用高于PCNL。两种治疗方式均安全有效。Objective To investigate the safety and efficacy of secondary surgery with percutaneous nephrolithotripsy(PCNL)or retrograde intrarenal surgery(RIRS)for the treatment of complex kidney stones of patients with a history of PCNL.Methods The clinical data of 76 patients with PCNL and 83 patients with RIRS patients who had a history of PCNL admitted to the Second Affiliated Hospital of Kunming Medical University from January 2017 to May 2022 were retrospectively analyzed.The differences in intraoperative blood loss,preoperative urinary tract infection,stone clearance rate,surgical time,hospitalization time,hospitalization cost,and postoperative complications between the two groups were compared.Results The results showed that there was no statistically significant difference in age,gender,body mass index,maximum diameter of stones,and urinary tract infection rate between the PCNL and RIRS group(P>0.05).The intraoperative blood loss was(23±11)g/L in the PCNL group and(16±7)g/L in the RIRS group,the intraoperative loss of hematocrit was(6.4±3.0)%and(4.5±2.1)%,the surgical time was(155±39)minutes and(118±33)minutes,the stone clearance was achieved in 49 cases(64.5%)and 66 cases(79.5%),the average hospital stay was(7.0±2.2)days and(5.6±1.5)days,and the treatment cost was(13978±3487)yuan and(19783±7239)yuan,respectively,all of which were statistically significant(P<0.05).There was no statistically significant difference in postoperative complications between the two groups(P>0.05).Conclusions For patients with complex kidney stones who have a history of PCNL,secondary surgery with RIRS is more effective than PCNL,but the treatment cost is higher than PCNL.Both treatment methods are safe and effective.

关 键 词：经皮肾镜 输尿管镜 二次手术 残石 

分 类 号：R699.2[医药卫生—泌尿科学]