组合式输尿管软镜和经皮肾镜治疗<2cm肾和输尿管上段结石的疗效比较

Modular flexible ureteroscopy versus PCNL for renal and upper ureter calculi less than 2 cm

目的:比较组合式输尿管软镜(PolyScope)和经皮肾镜(PCNL)治疗<2cm肾和输尿管上段结石的疗效。方法:分别采用输尿管软镜和经皮肾镜取石术治疗<2cm的肾和输尿管上段结石患者26例和47例,统计比较两种方法的手术时间、术后住院时间、并发症、住院费用及一次碎石成功率。结果:输尿管软镜组和经皮肾镜组的手术时间分别为(70.2±14.7)min和(49.2±11.9)min,术后住院时间分别为(3.7±1.1)d和(6.5±2.1)d,住院费用分别为(21 318±1 171)元和(13 474±1 428)元,差异均有统计学意义(P<0.01)。经皮肾镜组有7例出现感染、出血等不同程度并发症,输尿管软镜组无明显并发症,差异有统计学意义(P<0.05)。输尿管软镜组一次碎石成功率为80.8%,经皮肾镜组为95.7%,两者差异无统计学意义(P>0.05)。但对于下盏结石,前者一次碎石成功率仅44.4%,后者达88.2%,差异有统计学意义(P<0.05)。结论:组合式输尿管软镜治疗<2cm肾和输尿管上段结石,在并发症、住院时间上依然具有优势,但在处理肾下盏结石时,一次碎石成功率不如经皮肾镜。建议在术前对病例进行选择,肾下盏漏斗肾盂角过小的下盏结石不宜选择输尿管软镜治疗。

Objective： To compare the clinical effects of modular flexible ureteroscopy（PolyScope） and percuta- neous nephrolithotomy（PCNL） for renal and upper ureter calculi less than 2 cm. Method： The records of 73 patients who underwent either PolyScope （n = 26） or PCNL （n= 47） by standard techniques for renal and upper ureter calculi less than 2 cm were reviewed retrospectively. Data including operative time, postoperative hospital stay, complications, hospital fee and single-procedure success of stone-free rate were analyzed and compared in two groups. Result： The operative time of PolyScope group and PCNI, group were （70.2±14.7） min and （49.2±11.9） rain respectively. Postoperative hospital stay were （3.7±1.1） d and （6.5±2.1） d respectively. Hospital fee were （21 318±1 171） Yuan and （13 474±1 428） Yuan. The above data showed statistical differences （P〈0. 01）. All complications were observed in group of PCNL including six cases with hemorrhage and one case with septic shock, which the complication rate was significantly higher than that of PolySeope group （P〈0.05）. Single-procedure success of stone-free rate in PCNL group was 95.7%, which is better than another group （80.8%）. The above data showed there was no statisiteal difference （P〉0.05）. However, for lower calyx calculi, single- procedure success of stone-free rate in PolySeope group was only 44.4%, while PCNL group was 88.2%. There existed a statistical difference （P〈0.05）. Conclusion： Modular flexible ureteroseopy is superior to PCNI. for less than 2 cm renal and upper ureter calculi in terms of the occurrence of complications and hospital stay. However, it does not have advantages in dealing with lower calyx calculi compared with PCNL. We suggest that operative indi- cation should be accurately identified.