关于输尿管软镜对比经皮肾镜治疗2~3 cm单发肾结石有效性和安全性的研究  

Study on the Efficacy and Safety of Flexible Ureteroscope Versus Percuta⁃neous Nephrolithotomy in the Treatment of 2~3 cm Single Renal Calculi

作　　者：朱佳敏 温伟勇 温世和 ZHU Jiamin;WEN Weiyong;WEN Shihe(Department of Urology,Heyuan People's Hospital,Heyuan 517000,Guangdong,China)

机构地区：[1]河源市人民医院泌尿外科,广东河源517000

出　　处：《系统医学》2024年第17期132-136,共5页Systems Medicine

摘　　要：目的比较分析2~3 cm单发肾结石治疗时应用输尿管软镜碎石术(retrograde intrarenal surgery,RIRS)与经皮肾镜激光碎石术(percutaneous nephrolithotomy with laser lithotripsy,PCNL)治疗的有效性以及安全性。方法非随机选取2021年6月—2024年6月河源市人民医院收治的200例2~3 cm单发肾结石患者作为研究对象,按治疗方法不同分为两组,采用输尿管软镜治疗的120例患者为RIRS组,采用经皮肾镜治疗的80例患者为PCNL组。比较两组患者手术指标、肾功能指标、血清指标、疼痛情况、并发症发生率。结果RIRS组手术时间较长,但术中出血量、住院时间、住院费用、血红蛋白下降值均低于PCNL组,差异有统计学意义(P均<0.05)。RIRS组一期结石清除率低于PCNL组,差异有统计学意义(P<0.05)。术后,RIRS组尿素氮、血肌酐、降钙素原及白细胞计数低于PCNL组,RIRS组血红蛋白指标高于PCNL组,差异有统计学意义(P均<0.05)。RIRS组术后1、2 d疼痛评分均低于PCNL组,差异有统计学意义(P均<0.05)。RIRS组并发症发生率1.67%(2/120)低于PCNL组13.75%(11/80),差异有统计学意义(χ^(2)=11.531,P<0.05)。结论在治疗2~3 cm的单发肾结石患者时,采用RIRS以及PCNL均安全、有效,RIRS对人体损伤小、术后恢复快、并发症发生率低、疼痛轻微,PCNL一期手术结石清除率较高,手术时间短,术式选择还需结合患者需求、病情而定。Objective To compare and analyze the efficacy and safety of transurethral ureteroscopy and percutaneous nephrolithotomy in the treatment of 2~3 cm single renal calculi.Methods From June 2021 to June 2024,200 patients with 2~3 cm single renal calculi admitted to Heyuan People's Hospital were non-randomly selected as the research objects.According to different treatment methods,they were divided into two groups.120 patients treated with flexible ureteroscopy were RIRS group,and 80 patients treated with percutaneous nephrolithotomy were PCNL group.The sur-gical indexes,renal function indexes,serum indexes,pain conditions and incidence of complications were compared between the two groups.Results The operation time of RIRS group was longer than that of PCNL group,but the intra-operative blood loss,hospitalization time,hospitalization cost and hemoglobin decrease were lower than those of PCNL group,and the differences were statistically significant(all P<0.05).The one-stage stone clearance rate in the RIRS group was lower than that in the PCNL group,and the difference was statistically significant(P<0.05).After operation,urea nitrogen,serum creatinine,procalcitonin and white blood cell count in RIRS group were lower than those in PCNL group,and hemoglobin index in the RIRS group was higher than that in PCNL group,and the differences were statistically significant(all P<0.05).The pain scores of RIRS group were lower than those of PCNL group at 1 d and 2 d after operation,and the differences were statistically significant(both P<0.05).The incidence of complications in the RIRS group was 1.67%(2/120)lower than that in the PCNL group 13.75%(11/80),and the difference was statisti-cally significant(χ^(2)=11.531,P<0.05).Conclusion In the treatment of patients with single renal calculi of 2~3 cm,RIRS and PCNL are safe and effective.RIRS has little damage to human body,rapid postoperative recovery,low inci-dence of complications and mild pain.The stone clearance rate of PCNL is high,and the operation time is short.The choice

关 键 词：输尿管软镜 经皮肾镜 2~3 cm单发肾结石 有效性 安全性 

分 类 号：R692[医药卫生—泌尿科学]