输尿管软镜与经皮肾镜碎石术治疗多囊肾合并上尿路结石疗效对比

Comparison of Ureteroscopy and Percutaneous Nephrolithotomy In the Treatment of Polycystic Kidney Complicated with Upper Urinary Calculi

目的探讨输尿管软镜与经皮肾镜碎石术治疗多囊肾合并上尿路结石的临床疗效及安全性.方法回顾性分析2015年1月至2021年1月分别采用输尿管软镜钬激光碎石术(软镜组)及经皮肾镜钬激光碎石取石术(经皮肾镜组)治疗多囊肾合并上尿路结石32例,对比两组临床资料、治疗效果及并发症发生率.结果两组共32例患者,其中2例双侧肾结石患者采用了分期手术,软镜组19例,手术治疗20侧肾,经皮肾镜组13例,手术治疗14侧肾;两组性别、年龄、术前合并感染、术前肌酐、术前血红蛋白、术前结石大小比较,差异无统计意义(P>0.05);与经皮肾镜组比较,软镜组患者的住院时间短,血红蛋白下降值降低,差异有统计意义(P<0.05);软镜组术后2 d结石清除率较经皮肾镜组降低,比较差异有统计意义(P<0.05),术后4周,两组清石率比较,差异无统计意义(P>0.05).结论输尿管软镜钬激光碎石术治疗多囊肾合并上尿路结石,手术创伤小,并发症少,安全有效,但术后需要注意患者排石的随诊.

Objective To investigate the clinical efficacy and safety of ureteroscopy and percutaneous nephroscopy in the treatment of polycystic kidney complicated with upper urinary calculi.Methods From January 2015 to January 2021,32 cases of polycystic kidney complicated with upper urinary calculi were treated with ureteroscopic holmium laser lithotripsy(soft nephroscope group)and percutaneous nephrolithotomy(percutaneous nephroscopy group).The clinical data,treatment effect and incidence of complications were compared between the two groups.Results There were 32 patients in the two groups,of which 2 patients with bilateral renal calculi underwent staged surgery,19 patients in the soft nephroscope group,20 kidneys were surgically treated,and 13 patients in the percutaneous nephroscopy group,14 kidneys were surgically treated;there was no significant difference in gender,age,preoperative infection,preoperative creatinine,preoperative hemoglobin and preoperative stone size between the two groups(P>0.05);compared with the percutaneous nephroscope group,the soft nephroscope group had shorter hospital stay and less hemoglobin decrease.The difference between the two groups was statistically significant(P<0.05);the stone clearance rate in the soft nephroscope group was lower than that in the percutaneous nephroscope group 2 days after operation(P<0.05),and there was no significant difference between the two groups 4 weeks after operation(P>0.05).Conclusion Ureteroscopic holmium laser lithotripsy is safe and effective in the treatment of polycystic kidney complicated with upper urinary calculi;however,we should pay attention to the follow-up of stone removal after operation.