FURS与mPCNL治疗2~3 cm肾结石合并糖尿病患者的应用比较  

Comparison of flexible ureteroscopy and mini percutaneous nephrolithotomy for the treatment of 2-3 cm renal stones in patients with diabetes mellitus

作　　者：周永强 蒋民军 陈建春 柳正清 徐辰 Zhou Yongqiang;Jiang Minjun;Chen Jianchun;Liu Zhengqing;Xu Chen(Department of Urology,Suzhou Ninth Hospital Affiliated to Soochow University,Suzhou 215200,China;Department of Endocrinology,Suzhou Ninth Hospital Affiliated to Soochow University,Suzhou 215200,China)

机构地区：[1]苏州市第九人民医院泌尿外科,苏州215200 [2]苏州市第九人民医院内分泌科,苏州215200

出　　处：《国际泌尿系统杂志》2024年第5期769-773,共5页International Journal of Urology and Nephrology

基　　金：苏州市科技计划项目(SYSD2020232)。

摘　　要：目的比较输尿管软镜碎石术(FURS)与微小通道经皮肾镜取石术(mPCNL)治疗糖尿病患者合并2~3 cm肾结石的有效性与安全性。方法回顾性分析2021年1月至2022年7月在本院接受FURS或mPCNL的152例2~3 cm肾结石合并糖尿病患者的临床资料,其中接受mPCNL治疗的有48例(mPCNL组),接受FURS治疗的有104例(FURS组)。收集并比较两组患者的一般资料、结石相关资料、围手术期指标、并发症发生率、结石清除率及住院总费用。结果mPCNL组的手术时间短于FURS组,术后住院时间长于FURS组,手术费用、手术次数少于FURS组,术后即刻结石清除率高于FURS组,差异均有统计学意义(均P<0.05)。mPCNL组有15例(31.25%)实现了完全无管化,FURS组所有患者术中均留置了输尿管内支架管。两组均未发生重大术中并发症(包括小的输尿管穿孔),mPCNL组的术后并发症ClavienⅠ级和Ⅱ级多于FURS组(均P<0.05)。FURS组有5例术后发热需采用抗生素治疗,而mPCNL组有11例。mPCNL组中有1例患者因血红蛋白显著下降而需要输血,该患者输血后血红蛋白仍有进行性下降,故进行了超选择性肾动脉栓塞术。mPCNL组有2例患者术后发生输尿管内支架管移位,均在静脉麻醉下重新留置输尿管内支架管。对于肾盂结石或肾下盏结石,mPCNL组患者的术后即刻结石清除率高于FURS组[50.0%(25/50)vs.86.7%(13/15),38.9%(7/18)vs.90.0%(9/10),P=0.011、0.009]。结论对于存在肾结石长径为2~3 cm的糖尿病患者,mPCNL与FURS具有同等的治疗效果,但FURS治疗的患者出现手术并发症的概率更低,而接受mPCNL治疗的患者在手术时间、术后无管化、二次手术及住院总费用方面更有优势。ObjectiveTo compare the efficacy and safety of flexible ureteroscopy(FURS)and mini percutaneous nephrolithotomy(mPCNL)in the treatment of renal stones of 2-3 cm in patients with diabetes mellitus.MethodsThe clinical data of 152 patients with 2-3 cm kidney stones combined with diabetes who received FURS or mPCNL in our hospital from January 2021 to July 2022 were retrospectively analyzed.Among them,48 patients received mPCNL treatment(mPCNL group)and 104 patients received FURS treatment(FURS group).The general data,stone related data,perioperative indexes,complication rate,stone clearance rate and total hospitalization cost were collected and compared.ResultsThe operative time of mPCNL group was shorter than that of FURS group,the postoperative hospitalization time was longer than that of FURS group,the surgical cost and the number of operations were less than that of FURS group,and the immediate postoperative stone clearance rate was higher than that of FURS group,with statistical significance(all P<0.05).In mPCNL group,15 patients(31.25%)achieved complete catheterization,and in FURS group,all patients had intraoperative ureteral stent indwelling.There were no major intraoperative complications(including small ureteral perforation)in either group.The mPCNL group had more postoperative complications than FURS group,and Clavien gradeⅠand GradeⅡwere the most common complications.Postoperative fever required antibiotic treatment in 5 patients in the FURS group and 11 in the mPCNL group.One patient in the mPCNL group required blood transfusion due to a significant decrease in hemoglobin,and the patient still had a progressive decrease in hemoglobin after transfusion,so super-selective renal artery embolization was performed.In mPCNL group,2 patients had ureteral stent displacement after operation,and all of them were re-indwelled under intravenous anesthesia.For renal pelvis stones or subcalyceal stones,the immediate postoperative stone clearance rate in mPCNL group was higher than that in FURS group[50.0%(25/50)v

关 键 词：糖尿病 肾结石 输尿管镜检查 肾造口术 经皮 

分 类 号：R692.4[医药卫生—泌尿科学] R587.1[医药卫生—外科学]