PCNL和RIRS治疗肾及输尿管上段结石的临床效果比较

Comparison of the clinical effects of PCNL and RIRS in the treatment of renal and ureteral stones

目的:比较经皮肾镜钬激光碎石术(PCNL)和输尿管软镜下钬激光碎石术(RIRS)治疗肾和输尿管上段结石患者的临床效果。方法:2015年10月至2018年5月收治85例肾和输尿管上段结石患者,结石大小1～2 cm;经PCNL治疗者40例,RIRS治疗者45例;治疗8周后评估碎石效果。结果:RIRS组患者术中出血量、手术时间、卧床时间及住院时间均明显低于PCNL组(P <0. 05);治疗后RIRS组患者血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和尿中肾损伤因子1(Kim-1)水平显著低于PCNL组(P <0. 05);两组血肌酐(SCr)水平差异无统学意义(P> 0. 05);两组患者结石清除率差异无统计学意义(P> 0. 05); RIRS组患者不良反应发生率为8. 00%,显著低于PCNL组的32. 00%(P <0. 05)。结论:在对肾和输尿管上段结石患者进行治疗时,RIRS具有较高的临床应用价值。

Objective: To compare the clinical effects of percutaneous nephrolithotomy( PCNL) and retrograde intra-renal surgery( RIRS) ureteroscope holmium laser lithotripsy in the treatment of renal and upper ureteral calculi. Methods: 85 patients with renal and ureteral calculi were admitted between October 2015 and May 2018.The stone size was 1-2 cm. 40 patients were treated by PCNL and 45 patients were treated by RIRS. The effect of lithotripsy was evaluated and compared after 8 weeks of treatment. Results: The intraoperative blood loss,operation time,bed time and hospitalization time in the RIRS group were significantly less than those in the PCNL group( P < 0. 05). After treatment,the levels of blood NGAL and urinary Kim-1 were significantly lower in the RIRS group( P < 0. 05). There was no significant difference in the SCr level and stone clearance rate between the two groups. The incidence of adverse reactions in the RIRS group( 8. 00%) was significantly lower than that in the PCNL group( 32. 00%,P < 0. 05). Conclusion: RIRS ureteroscopic holmium laser lithotripsy may have high clinical value than PCNL in patients with upper kidney and ureteral calculi( less than 2 cm).