输尿管镜下钬激光碎石与经皮肾镜取石术治疗肾结石的疗效比较

Management of renal calculi： retrograde ureteroscopic holminum laser versus percutaneous nephrolithotripsy

目的 探讨直径≤3 cm肾结石的最佳微创治疗方法. 方法 回顾性分析2008年2月至2011年4月收治≤3 cm的109例117侧肾结石患者的临床资料及治疗方法.其中采用输尿管硬镜和软镜钬激光碎石术64例（67侧）,采用经皮肾镜钬激光碎石取石术（PCNL） 45例（50侧）.比较分析两种方法治疗结石的手术时间、碎石成功率、血红蛋白下降值、术后住院天数、住院费用和并发症. 结果 输尿管镜组患者肾结石直径为（2.5±0.9）cm,PCNL组患者为（2.4±0.7）cm,组间比较差异无统计学意义（P＞0.05）.输尿管镜组手术均顺利完成,其中43例术中换用输尿管软镜击碎冲入肾盏的结石,术后发热3例,未出现严重并发症.PCNL组手术均顺利完成,术后发热2例,术中、术后明显出血1例,经选择性肾动脉栓塞治愈.输尿管镜组和PCNL组手术时间分别为（117.0±36.5） min及（90.0±18.3） min,一期结石清除率分别为94％（63/67）及92％ （46/50）,组间比较差异无统计学意义（P＞0.05）；血红蛋白分别下降（0.3±0.1） g/L及（20.6±8.1）g/L,住院天数分别为（5.0±2.4）d及（7.0±3.7）d,住院费用分别为（15 477.0±754.3）元及（27 453.0±1763.5）元,组间比较差异均有统计学意义（P＜0.05）. 结论 对于≤3 cm的肾结石,输尿管镜下碎石与PCNL疗效相近,而输尿管镜下碎石还具有创伤小、住院天数少、治疗费用低及并发症发生率低的优势.

Objective To compare the therapeutic effect of retrograde ureteroscopic Ho：YAG laser lithotripsy （UHL） and percutaneous nephrolithotripsy （PCNL） in treating patients with renal calculi of ~〈 3 cm. Methods From Feb. 2008 to Apr. 2011, a total of 109 cases （117 renal calculi in total ） treated by either PCNL （50） or UHL （67） were retrospectively analyzed. Operative time, stone free rate, postopera- tive hospital stay, hospitalization expenses and complications were compared in the 2 groups. Results The mean stone burden of the UHL group and PCNL group was 2.5 cm （1.5-3.0） cm and 2.4 cm （1.3-3.0） cm, respectively. There was no significant difference in two groups. In UHL group, operations were per- formed successfully in all 67 calculi, of whom, 43 patients needed combination of flexible ureteroscopy to break the stone fragments falling into the renal calices. No serious complication was recorded except postoper- ative fever in 3 cases. In PCNL group, all patients had been successful operated. Postoperative fever oc- curred in 2 cases. Obvious intraoperative and postoperative haemorrhage appeared in 1 case, and cured by selective renal artery embolization. The operation time of the UHL group and PCNL group was （117.0~36.5） rain and （90.0＋18.3） rain respectively, and had no significant difference in two groups （P〉0.05）. The stone free rate of the UHL group and PCNL group was 94% （63/67） and 92% （46/50） respectively, and had no significant difference in two groups （P〉0.05）. Hemoglobin decline of the UHL group and PCNL group was （0.3~0.1） g/L and （20,6~8.1） g/L, and had significant difference in two groups （P〈0.05）.Postoperative hospital stay of the UHL group and PCNL group was （5.0＋2.4） day and （7.0＋3.7） day, and had statistical difference in two groups （P〈 0.05）. Hospitalization expenses of the UHL group and PCNL group was （ 15 477.0＋ 754.3 ） RMB and （ 27 453.0 ＋ 1763.5 ） RMB, and had statistical difference in two groups （P〈0.05）. Conclusions Although UHL and PCNL have similar curative effect in treating renal stones of less than 3 cm, UHL have the advantages of less trauma and complication, lower expenses and fe- wer hospital stay. In treating renal stones of smaller than 3 cm, especially in the contraindication of PCNL, UHL may be a better choice.