标准通道与微通道经皮肾镜取石术在治疗2~4 cm高CT值结石中的疗效与安全性分析  

Analysis of the efficacy and safety of standard channel and miniature channel percutaneous nephrolithotomy in treating 2-4 cm high CT value stones

作　　者：俞文韬 张冠 龚蔚 刘伟 高磊 刘言 杨家荣 伍依依 刘振宇 潘铁军 YU Wentao;ZHANG Guan;GONG Wei;LIU Wei;GAO Lei;LIU Yan;YANG Jiarong;WU Yiyi;LIU Zhenyu;PAN Tiejun(Graduate Student Joint Training Base of Central Theater Command General Hospital of Wuhan University of Science and Technology,Wuhan,430070,China;Medical College,Wuhan University of Science and Technology;Deparment of Urology,the 990th Hospital of PLA;Department of Urology,Central Theater Command General Hospital of PLA)

机构地区：[1]武汉科技大学中部战区总医院研究生联合培养基地,武汉430070 [2]武汉科技大学医学部医学院 [3]联勤保障部队第990医院泌尿外科 [4]中部战区总医院泌尿外科

出　　处：《临床泌尿外科杂志》2025年第3期246-253,共8页Journal of Clinical Urology

基　　金：湖北省自然科学基金青年项目(No:2023AFB498);武汉市自然科学基金探索计划(晨光计划)项目(No:2024040801020363);中部战区总医院博士后科研启动基金(No:20230102KY39)。

摘　　要：目的:比较标准通道经皮肾镜取石术(standard channel percutaneous nephrolithotomy,SPCNL)与微通道经皮肾镜取石术(miniature channel percutaneous nephrolithotomy,MPCNL)在治疗2~4 cm高CT值结石中的疗效与安全性。方法:回顾性分析2022年1月—2023年12月在我院行经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗的2~4 cm高CT值结石患者143例,根据术中通道大小分成2组,分别为SPCNL组(术中通道大小24F)76例,MPCNL组(术中通道大小18F)67例。对2组患者的术后结石清除率(stone free rate,SFR)、手术时间、术后血红蛋白下降量、术后全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)、并发症Clavien分级、术后白细胞计数等临床资料进行比较。结果:2组手术均顺利完成。在单发结石中SPCNL组的SFR与MPCNL组比较,差异无统计学意义(88.9%vs 96.2%,P>0.05);在面对多发结石与鹿角型结石中SPCNL组的结石清除率均高于MPCNL组,均差异有统计学意义(91.4%vs 68.0%,91.3%vs 43.8%;P<0.05)。SPCNL组中单发结石、多发结石和鹿角型结石手术时间均分别短于MPCNL组,差异有统计学意义[59(40.5,69.0) min vs 71.5(60.0,80.3) min,79.0(69.0,87.0) min vs 103.0(93.5,109.5) min,115.0(107.0,123.0) min vs 142.5(127.0,148.8) min;P<0.05]。对于术后SIRS、并发症Clavien分级、术后白细胞计数、术后降钙素原及白介素-6等指标均差异无统计学意义(P>0.05)。结论:在单发2~4 cm高CT结石情况下,SPCNL与MPCNL均为有效的治疗手段,且SPCNL相比MPCNL手术时间更短。对于2~4 cm多发结石或鹿角型结石,SPCNL具有术后结石清除率高、手术时间短,并且安全性不输于MPCNL的优势。Objective:To compare the efficacy and safety between standard channel percutaneous nephrolithotomy(SPCNL) and miniature channel percutaneous nephrolithotomy(MPCNL) in treating 2-4 cm high CT value stones.Methods:A retrospective analysis was conducted on 143 patients with 2-4 cm high CT value stones who underwent PCNL in our hospital from January 2022 to December 2023.Patients were divided into two groups based on the channel size:SPCNL(24F,n=76) and MPCNL(18F,n=67).Clinical data such as stone free rate(SFR),operation time,postoperative hemoglobin drop,systemic inflammatory response syndrome(SIRS),Clavien grade complications,and postoperative white blood cell count were compared between the two groups.Results:Both procedures were successfully completed.In the case of single stone,the SFR of the SPCNL group was similar to that of the MPCNL group,with no statistical difference(88.9% vs 96.2%,P>0.05);in the case of multiple stones and staghorn stones,the SFR of the SPCNL group was higher than that of the MPCNL group,with statistical differences(91.4% vs 68.0%,91.3% vs 43.8%;P<0.05).The operative time for single,multiple and staghorn calculi in the SPCNL group was shorter than that in the MPCNL group,respectively,with statistically significant differences(59.0[40.5,69.0] min vs 71.5[60.0,80.3] min,79.0[69.0,87.0] min vs 103.0[93.5,109.5] min,115.0[107.0,123.0] min vs 142.5[127.0,148.8] min;P<0.05).There were no statistical differences in postoperative SIRS,Clavien grade complications,white blood cell count,procalcitonin,and interleukin-6 between the two groups(P>0.05).Conclusion:In the case of single 2-4 cm high CT stone,SPCNL and MPCNL are both effective treatments,and SPCNL has shorter operation time than MPCNL.In the case of multiple stones of 2-4 cm or staghorn stones,SPCNL has the advantages of high postoperative SFR,short operation time,and safety that is not inferior to MPCNL.

关 键 词：经皮肾镜取石术 高CT值结石 通道大小 结石清除率 全身炎症反应综合征 

分 类 号：R691.4[医药卫生—泌尿科学]