输尿管软镜联合硬镜钬激光碎石术与微通道经皮肾取石术治疗复杂性输尿管上段结石的应用比较

Comparison of Flexible Ureteroscope Combined with Rigid Ureteroscope Holmium Laser Lithotripsy and Minimally Invasive Percutaneous Nephrolithotomy for the Treatment of Complex Upper Ureteral Calculi

目的比较输尿管软镜联合硬镜(flexible ureteroscope combined with rigid ureteroscope,F-RURS)钬激光碎石术与微通道经皮肾取石术(minimally invasive percutaneous nephrolithotomy,mPCNL)对复杂性输尿管上段结石的治疗效果。方法对作者单位2017年6月至2019年6月期间收治的105例复杂性输尿管上段结石患者进行回顾性分析,根据手术方法的不同分为F-RURS组(F-RURS钬激光碎石术,54例)和mPCNL组(mPCNL取石术,51例)。比较两组手术时间、术中失血量、术后住院时间、结石清除率、肾功能改变和术后并发症发生情况。结果F-RURS组手术时间长于mPCNL组(P<0.05),术后住院时间短于mPCNL组(P<0.05),术中失血量低于mPCNL组(P<0.05);F-RURS组术后7天、1个月结石清除率高于mPCNL组(P<0.05),术后3个月两组结石清除率比较无统计学意义(P>0.05);F-RURS组术后7天血清肌酐升高率低于mPCNL组(P<0.05),术后1个月、3个月与mPCNL组比较无差异(P>0.05);F-RURS组术后7天、1个月所测肾小球滤过率(glomerular filtration rate,GFR)高于mPCNL组(P<0.05),术后3个月与mPCNL组比较无差异(P>0.05);F-RURS组并发症发生率9.26%,与mPCNL组(15.69%)比较无显著统计学差异(P>0.05)。结论F-RURS钬激光碎石术与mPCNL在复杂性输尿管上段结石治疗中均有良好的治疗效果,其中F-RURS钬激光碎石术术中失血量少,术后住院时间短,结石清除快,肾功能恢复快。

Objective To investigate the effect of flexible ureteroscope combined with rigid ureteroscope(F-RURS)holmium laser lithotripsy and minimally invasive percutaneous nephrolithotomy(mPCNL)for the treatment of complex upper ureteral calculi.Methods A retrospective analysis was made on 105 patients with complex upper ureteral calculi admitted to the hospital from June 2017 to June 2019.According to the different operation methods,they were divided into F-RURS group(54 cases)and mPCNL group(51 cases).The operation time,intraoperative blood loss,postoperative hospital stay,stone clearance rate,renal function changes and postoperative complications were compared between the two groups.Results The average operation time of the F-RURS group was longer than that of the mPCNL group(P<0.05),the postoperative hospitalization time was shorter than that of mPCNL group(P<0.05),and the intraoperative blood loss was lower than that of mPCNL group(P<0.05).Seven days or 1 month after the operations,the stone clearance rate of the F-RURS group was higher than that of mPCNL group(P<0.05).The level of C reactive protein in F-RURS group was lower than that in mPCNL group(P<0.05).Seven days after operation,the serum creatinine in F-RURS group was lower than that in mPCNL group(P<0.05).Seven days or 1 month after the operations,the glomerular filtration rate(GFR)of F-RURS group was higher than that of mPCNL group(P<0.05).There was no significant difference on the complications between F-RURS group and mPCNL group(9.26%vs 15.69%)(P>0.05).Conclusions Both the F-RURS holmium laser lithotripsy and the mPCNL were effective for the treatment of complicated upper ureteral calculi.In contrast,F-RURS holmium laser lithotripsy has less blood loss,shorter hospital stay,faster stone removal and faster recovery of renal function.