逆行肾内手术治疗直径2~3cm肾结石的临床应用  

Clinical application of retrograde intrarenal surgery for the treatment of kidney stones measuring 2~3cm in diameter

作　　者：周晓波[1] 李茂章[1] ZHOU Xiao-bo;LI Mao-zhang(Department of Urology,Huizhou Central People's Hospital,Huizhou,Guangdong 516001,China)

机构地区：[1]惠州市中心人民医院泌尿外科,广东惠州516001

出　　处：《岭南现代临床外科》2024年第2期116-120,共5页Lingnan Modern Clinics in Surgery

基　　金：广东省自然科学基金-面上项目(2114050001591);惠州市科技计划项目(2023CZ010070)。

摘　　要：目的 探讨逆行肾内手术(RIRS)治疗直径2~3 cm肾结石的临床应用。方法 选取2022年1月到2023年3月我院诊治的直径2~3 cm肾结石患者80例,根据手术方式的不同分为观察组(逆行肾内手术RIRS组,n=40)和对照组(经皮肾镜碎石术PCNL组,n=40)。比较两组患者一般情况和结石特征、术中指标及术后恢复情况。结果 两组患者各项一般情况数据和结石特征比较差异无统计学意义(P>0.05);RIRS组患者血红蛋白下降量低于PCNL组,差异有统计学意义(P<0.05),其余围手术期数据比较差异无统计学意义(P>0.05);RIRS组患者术后住院时间、总并发症低于PCNL组,差异有统计学意义(P<0.05);术后一个月,RIRS组结石清除34例(85.00%),PCNL组患者结石清除36例(90.00%),两组结石清除率比较差异无统计学意义(P>0.05)。结论对于直径2~3 cm的较大肾结石患者采用输尿管软镜碎石术与经皮肾镜碎石术的手术时间、结石清除率、引起术后PCT的升高方面相当,输尿管软镜碎石术患者出血更少,恢复更快,术后住院时间更短,并发症发生率更低。Objective To investigate the clinical application of retrograde intrarenal surgery(RIRS) in the treatment of kidney stones measuring 2-3 cm in diameter.Methods A total of 80 patients with kidney stones with a diameter of 2-3 cm treated in our hospital from January 2022 to March 2023 were selected and divided into observation group(retrograde intrarenal surgery RIRS group,n=40) and control group(percutaneous nephrolithotripsis PCNL group,n=40) according to different surgical methods.The general condition,stone characteristics,intraoperative indexes and postoperative recovery of the two groups were compared.Results There was no significant difference between the two groups in general condition data and stone characteristics(P>0.05).The decrease of hemoglobin in RIRS group was lower than that in PCNL group,the difference was statistically significant(P<0.05),but there was no statistically significant difference in other perioperative data(P>0.05).The length of hospital stay and total complications in RIRS group were lower than those in PCNL group,and the differences were statistically significant(P<0.05).One month after surgery,34 patients(85.00%) in the RIRS group and 36 patients(90.00%) in the PCNL group were cleared of stone,and there was no significant difference in stone clearance between the two groups(P>0.05).Conclusion The use of ureteral flexible lithotripsy in patients with larger renal stones of 2-3 cm in diameter is comparable to percutaneous nephrolithotripsy in terms of operative time,stone clearance,and causing postoperative elevation of PCT.Patients with ureteral soft lithotripsy have less bleeding,faster recovery,shorter postoperative hospital stay and lower complication rate.

关 键 词：肾结石 逆行肾内手术 经皮肾镜碎石术 血红蛋白 降钙素原 

分 类 号：R692.4[医药卫生—泌尿科学]