头端可弯曲负压吸引鞘、常规鞘输尿管软镜手术与经皮肾镜治疗>2 cm上尿路结石的疗效比较  

A comparative study of RIRS with flexible negative pressure aspiration,RIRS with conventional sheath and PCNL in the treatment of heavy load upper urinary tract stones

作　　者：庄承霖 庄宝钧 吕继宗 武冠宇 穆振东 阳鑫 刘飞 郑伟[1] ZHUANG Chenglin;ZHUANG Baojun;LYU Jizong;WU Guanyu;MU Zhendong;YANG Xin;LIU Fei;ZHENG Wei(Department of Urology,The Second Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712046;Department of Andrology,Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610032;Department of Urology,Xijing Hospital of The Air Force Medical University,Xi'an 710032,China)

机构地区：[1]陕西中医药大学第二附属医院泌尿外科,陕西咸阳712046 [2]成都中医药大学附属医院男科,四川成都610032 [3]空军军医大学西京医院泌尿外科,陕西西安710032

出　　处：《现代泌尿外科杂志》2024年第10期875-879,共5页Journal of Modern Urology

摘　　要：目的 探究头端可弯曲负压吸引鞘肾内逆行手术(RIRS)治疗>2 cm上尿路结石的疗效与安全性,为此类疾病的诊治提供参考。方法 回顾性分析2022年11月—2023年11月于陕西中医药大学第二附属医院行上尿路结石手术的155例患者的资料,根据手术方式将患者分为经皮肾镜碎石取石术(PCNL)组(54例)、常规鞘RIRS组(41例)和可弯鞘RIRS组(60例),比较3组患者的一般及临床资料。结果 术前PCNL组较常规鞘RIRS组和可弯鞘RIRS组的重度肾积水患者占比更高(22.22%vs. 4.88%vs.5.00%,P=0.027)、累及肾下盏的肾盂漏斗夹角(IPA)更小[(36.17±17.6)°vs.(48.57±17.56)°vs.(47.41±10.82)°,P=0.014]。术后3 d PCNL组、常规鞘RIRS组和可弯鞘RIRS组患者的结石清除率(SFR)分别为90.74%、53.66%和78.33%(P<0.05);术后1个月的SFR分别为92.59%、73.17%、81.67%,术后1个月PCNL组与可弯鞘RIRS组的SFR比较差异无统计学意义(P>0.05),但高于常规鞘RIRS组(P<0.05)。PCNL组较常规鞘RIRS组和可弯鞘RIRS组手术时间更短[(65.22±17.67)min vs.(91.73±20.57)min vs.(94.38±24.75)min,P<0.001],术后住院时间更长[5.0(4.0,7.0)d vs. 3.0(2.0,4.0)d vs.3.0(2.0,4.0) d,P<0.001]、血红蛋白下降值更大[(18.00±5.78)g/L vs.(5.57±5.16)g/L vs.(7.42±5.09)g/L,P<0.001]、视觉模拟评分(VAS)更高[(4.83±1.48)分vs.(2.95±1.07)分vs.(3.05±1.21)分,P<0.001],而常规鞘RIRS组和可弯鞘RIRS组间差异无统计学意义(P>0.05)。同时,可弯鞘RIRS组花费少于常规鞘RIRS组而多于PCNL组[(23 311.19±1 341.20)元vs.(24 550.49±1 172.51)元vs.(15 351.97±1 101.4)元,P<0.001]。3组的总体并发症发生率比较差异无统计学意义,其中3例“石街”患者均来自常规鞘RIRS组。结论 对于>2 cm的上尿路结石患者,RIRS比PCNL术后住院时间、血红蛋白下降值更小,VAS评分更低。可弯鞘RIRS术后早期SFR优于常规鞘RIRS,术后1月SFR与PCNL相当,且“石街”发生率低。Objective To explore the efficacy and safety of retrograde intrarenal surgery(RIRS)using a flexible negative pressure suction sheath in the treatment of upper urinary tract stones>2 cm in diameter,to provide reference for the diagnosis and treatment of such disease.Methods Clinical data of 155 patients who underwent surgery for upper urinary tract stones during Nov.2022 and Nov.2023 at the Second Affiliated Hospital of Shaanxi University of Chinese Medicine were retrospectively analyzed.The patients were divided into 3 groups:percutaneous nephrolithotripsy(PCNL)group(n=54),conventional sheath RIRS group(n=41),and flexible sheath RIRS group(n=60).The general and clinical data of the 3 groups were compared.Results The PCNL group had more patients with severe hydronephrosis(22.22%vs.4.88%,5.00%,P=0.027)and smaller IPA involving the lower calyx[(36.17±17.6)°vs.(48.57±17.56)°,(47.41±10.82)°,P=0.014]than the conventional sheath RIRS group and flexible sheath RIRS group.Three days after operation,the stone-free rate(SFR)was 90.74%,53.66%and 78.33%in the PCNL,conventional sheath RIRS,and flexible sheath RIRS groups,respectively(P<0.05).At 1 month postoperatively,the SFR was 92.59%,73.17%,and 81.67%,with no statistically significant difference between the PCNL and flexible sheath RIRS groups(P>0.05),but was higher than that in the conventional sheath RIRS group(P<0.05).The PCNL group had shorter operation time than the two RIRS groups[(65.22±17.67)min vs.(91.73±20.57)min,(94.38±24.75)min,P<0.001],longer postoperative hospital stay[(5.0(4.0,7.0)d vs.3.0(2.0,4.0)d,3.0(2.0,4.0)d,P<0.001],greater decrease in hemoglobin level[(18.00±5.78)g/L vs.(5.57±5.16)g/L,(7.42±5.09)g/L,P<0.001],and higher visual analogue scale(VAS)score[(4.83±1.48)min vs.(2.95±1.07)min,(3.05±1.21)min,P<0.001],while there was no difference between the two RIRS groups(P>0.05).The costs were lower in the flexible sheath RIRS group than in the conventional sheath RIRS group but higher than in the PCNL group[(23311.19±1341.20)yuan vs.(24550.49�

关 键 词：头端可弯曲负压吸引鞘 逆行肾内手术 经皮肾镜碎石术 上尿路结石 

分 类 号：R691.4[医药卫生—泌尿科学]