2种微创方法治疗CT值≤1200 HU的2~4 cm肾结石的疗效对比  

Comparative Study of Mini-percutaneous Nephrolithotomy and Flexible Ureteroscopic Lithotripsy in the Treatment of 2-4 cm Renal Stones With CT Value≤1200 HU

作　　者：付汉川 晋学飞[1] 李宏岩[1] Fu Hanchuan;Jin Xuefei;Li Hongyan(China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]吉林大学中日联谊医院泌尿外科,长春130033

出　　处：《中国微创外科杂志》2023年第8期576-580,共5页Chinese Journal of Minimally Invasive Surgery

基　　金：吉林省科学技术厅资助项目(20200201445JC)。

摘　　要：目的比较输尿管软镜碎石术(flexible ureteroscopic lithotripsy,FURL)与微通道经皮肾镜取石术(mini-percutaneous nephrolithotomy,mPCNL)治疗CT值≤1200 HU的2~4 cm肾结石的临床疗效。方法回顾性分析我院2020年1月~2021年12月72例CT值≤1200 HU的2~4 cm肾结石的临床资料,36例行FURL(软镜组),36例行mPCNL(肾镜组),比较2组手术时间、术后疼痛视觉模拟评分(Visual Analogue Scale,VAS)、肾功能、感染情况和结石清除率。结果所有手术均顺利完成。2组手术时间差异无显著性[(75.4±32.0)min vs.(82.1±28.3)min,t=-0.944,P=0.349]。肾镜组术后住院时间明显长于软镜组[(6.0±2.4)d vs.(4.4±1.3)d,t=-3.481,P=0.001],术后疼痛VAS评分明显高于软镜组[(5.2±1.2)分vs.(2.5±0.8)分,t=-10.925,P=0.000],术后血红蛋白下降幅度更大[16.5(15.0,23.0)g/L vs.6.5(1.5,13.0)g/L,Z=-4.894,P=0.000]。2组术后1周、3个月结石清除率差异无显著性[91.7%(33/36)vs.94.4%(34/36),χ^(2)=0.215,P=0.643;97.2%(35/36)vs.97.2%(35/36),χ^(2)=0.000,P=1.000]。2组肾功能、术后发热及感染情况差异无显著性(P>0.05)。结论对于CT值≤1200 U的2~4 cm肾结石,FURL与mPCNL具有相同的疗效,但FURL术中出血更少、创伤更小,术后恢复时间更短,住院时间更短。Objective To compare the clinical efficiency of flexible ureteroscopic lithotripsy(FURL)and mini-percutaneous nephrolithotomy(mPCNL)in the treatment of 2-4 cm kidney stones with CT value≤1200 HU.Methods A total of 72 cases of kidney stones with CT value≤1200 HU from January 2020 to December 2021 were retrospectively analyzed.There were 36 cases treated with FURL(FURL group)and 36 cases treated with mPCNL(mPCNL group).The operation time,pain visual analogue score(VAS),renal function,infection status,and stone clearance rate were compared between the two groups.Results All the operations were successfully completed.There was no significant difference in the operation time between the two groups[(75.4±32.0)min vs.(82.1±28.3)min,t=-0.944,P=0.349].The mPCNL group had longer postoperative hospital stay[(6.0±2.4)d vs.(4.4±1.3)d,t=-3.481,P=0.001],higher postoperative VAS score[(5.2±1.2)points vs.(2.5±0.8)points,t=-10.925,P=0.000],and more postoperative hemoglobin decrease[16.5(15.0,23.0)g/L vs.6.5(1.5,13.0)g/L,Z=-4.894,P=0.000]as compared to the FURL group.There were no significant differences in short-term and long-term stone clearance rates between the two groups[91.7%(33/36)vs.94.4%(34/36),χ^(2)=0.215,P=0.643;97.2%(35/36)vs.97.2%(35/36),χ^(2)=0.000,P=1.000].There were no significant differences in renal function,postoperative fever,and infection between the two groups(P>0.05).Conclusions For 2-4 cm renal stones with CT value≤1200 HU,FURL and mPCNL have the same surgical effect.FURL is recommended for its less intraoperative bleeding,less trauma,shorter postoperative recovery time,and shorter hospital stay.

关 键 词：肾结石 输尿管软镜碎石术 微通道经皮肾镜取石术 CT值 

分 类 号：R699.2[医药卫生—泌尿科学]