组合式输尿管软镜联合钬激光碎石术与经皮肾镜碎石术治疗肾结石对比研究

Flexible ureteroscope lithotripsy combined with holmium laser lithotripsy vs. percutaneous nephrolithotomy for renal calculi

目的:比较分析组合式输尿管软镜碎石术(FURL)联合钬激光碎石术与经皮肾镜碎石术(PCNL)治疗肾结石的疗效。方法:回顾性分析内江市第二人民医院泌尿外科2015年1月-2017年6月收治115例肾结石患者的病例资料,根据不同术式将其分为FURL组(65例)与PCNL组(50例)。测定入组患者的结石负荷,结石位置,结石数量,术前、术后24 h白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、血红蛋白(Hb)水平,记录两组的手术时间、术中出血量、术后并发症、术后住院时间、术后1个月结石清除率。结果:FURL组手术时间、术中出血量、术后住院时间均显著少于PCNL组(P<0.05);FURL组结石负荷<2 cm的结石清除率、位于下盏的结石清除率、单个结石清除率分别为69.56%、46.87%、66.67%,均显著低于PCNL组的96.77%、100.00%、100.00%(P<0.05);FURL组并发症总发生率为9.23%,显著低于PCNL组(P<0.05);两组术后24 h WBC、hs-CRP比术前均显著上升,Hb显著下降,差异有统计学意义(P<0.05);FURL组术后24 h的hs-CRP水平显著低于PCNL组、Hb显著高于PCNL组(P<0.05)。结论:PCNL对结石负荷<2 cm、下盏或单个的肾结石,结石清除率优于FURL,但相比PCNL,FURL治疗肾结石手术时间短、出血量少、术后并发症少。

Objective:To compare and analyze the curative effect of flexible ureteroscope lithotripsy(FURL)combined with holmium laser lithotripsy vs. percutaneous nephrolithotomy(PCNL)for renal calculi.Methods:The clinical data of 115 patients with renal calculi who were admitted to the Neijiang Second People’s Hospital from January 2015 to June 2017 were retrospectively analyzed. According to different operative methods,the patients were divided into FURL group(65 cases)and PCNL group(50 cases). The stone load,stone location,number of stones,counts of white blood cells(WBC),high-sensitivity C-reactive protein(hs-CRP)and hemoglobin(Hb)at 24 h after surgery were measured. The operation time,intraoperative blood loss,postoperative complications,postoperative hospital stay and stone clearance rate at 1 st month after surgery were recorded.Results:The operation time,intraoperative blood loss and postoperative hospital stay in FURL group were significantly reduced as compared with those in PCNL group(P<0.05). The tone clearance rate of stone load less than 2 cm,tone clearance rate at calyx and single tone clearance rate in FURL group were 69.56%,46.87%,and 66.67%,respectively,significantly lower than those in PCNL group(96.77%,100.00% and 100.00%)(P<0.05). The total incidence of complications in FURL group(9.23%)was significantly lower than that in PCNL group(P<0.05). WBC counts and hs-CRP in the two groups were significantly increased,while Hb levels were significantly decreased at 24 h after suegery(P<0.05). The hsCRP levels in FURL group at 24 h after surgery were significantly lower than those in PCNL group,and Hb was significantly higher than that in PCNL group(P<0.05).Conclusion:The tone clearance rates of PCNL are higher than those of FURL in terms of stone load less than 2 cm,calyx or single stone. Compared with PCNL,there are advantages of FURL in treatment of renal calculi,such as shorter operation time,less bleeding volume and less postoperative complications.