逆行肾内手术治疗不同大小肾结石的疗效分析

Outcomes of retrograde intra-renal surgery(RIRS) for different size of renal stones

目的探讨逆行肾内手术(RIRS)治疗肾结石的临床疗效、安全性及适应证。方法回顾性分析2008年3月至2013年5月采用RIRS治疗432例肾结石患者的临床资料,对患者手术时间、术后结石清除率、并发症发生率进行评估。结果本组RIRS术432例,其中≤2 cm结石患者272例,平均手术时间为(81.6±23.7)min,一期结石清除率为87.8%;2 cm至3 cm肾结石133例,平均手术时间为(163.3±71.5)min,一期结石清除率为72.2%;>3 cm结石27例,平均手术时间为(163.3±58.3)min,一期结石清除率为40.7%。术中发生输尿管穿孔性损伤17例(3.9%),术后22(5.1%)例体温超过38.5℃,7例(1.6%)出现尿脓毒血症,经抗感染及支持治疗等治疗缓解。比较结石直径≤2 cm组和2 cm<直径≤3 cm的一期清石率,无显著性差异(P>0.05);比较结石直径≤2 cm组和结石直径>3 cm的一期清石率,有显著性差异(P<0.05)。结论对于≤3 cm的肾结石,RIRS具有创伤小,恢复快,结石清除率高等优点,值得推广。

Objective To investigate the clinical effect, safety and indication of retrograde intra-renal surgery （RIRS） for renal stones. Methods The data of 432 patients who underwent RIRS for renal stones from March 2008 to May 2013 were retrospectively reviewed. Factors such as stone-free rate （SFR）, operation duration, complications were analyzed. Results A total of 432 RIRS were included in our study. For the 272 cases whose stones burden ≤2 cm, the mean operative duration was （81.6±23.7）rain, the SFR was 87.8% at the stage-staged procedure. For stone burden between 2 and 3 cm, the mean operative duration was （163.3±71.5）min, the SFR of first stage was 72.2%. For the cases whose stone burden more than 3 cm, the mean operative duration was （163.3±58.3）min, the SFR of first stage was 40.7%. The postoperative complications included minimal ureteral perforation （3.9%）, fever （5.1%）, sepsis （1.6%）, who were recovered after anti-inflammation and supporting treatment. To compare the SFR of stone burden ≤2 cm and from 2 cm to 3 cm, the difference was not statistically significant （P〈0.05）, but there was statistical difference when compared the SFR of stone burden mare than 3 cm and less than 3 cm （P〉0.05）. Conclusion RIRS could be one of the effective methods in the treatment of renal stones less than 3 cm.