经皮肾镜与输尿管软镜治疗肾结石的比较研究

Percutaneous nephrolithotomy versus flexible ureteroscope holmium laser lithotripsy for renal calculi

目的 比较经皮肾镜碎石取石术和输尿管软镜钬激光碎石术治疗1～2cm肾结石,探讨1～ 2cm肾结石的适宜治疗方案.方法 选取2014年3月至2015年3月山西省长治市人民医院泌尿外科收治的单侧肾结石47例,结石直径1～ 2cm,将其随机分为经皮肾镜碎石术组24例和输尿管软镜钬激光碎石术组23例,分别行手术治疗,比较两种术式患者的年龄、性别、结石数目、结石大小、手术时间、术后无石率、术中出血量、术后高热发生率,术后疼痛、住院天数和手术费用.结果 两组年龄、性别、结石数目及结石大小差异无统计学意义（P＞0.05）,具有可比性.经皮肾镜碎石取石术组手术时间（57.9±13.4） min,输尿管软镜钬激光碎石术组（54.3±12.9） min,差异无统计学意义（P＞0.05）.经皮肾镜碎石取石术组有2例有残留结石,清除率为91.7％,输尿管软镜钬激光碎石术组有3例有残留结石,清除率为86.9％,差异无统计学意义（P＞0.05）.输尿管软镜钬激光碎石术组术中出血（44.6±15.3） ml,经皮肾镜碎石取石术组出血量（76.1±17.2）ml,差异有统计学意义（P＜0.05）.输尿管软镜钬激光碎石术组术后高热发生率13.0％ （3/23）,经皮肾镜碎石取石术组术后高热发生率16.7％（4/24）,差异无统计学意义（P＞0.05）.经皮肾镜碎石取石术组术后镇痛发生率20.8％ （5/24）,输尿管软镜钬激光碎石术组术后未使用镇痛药物,差异有统计学意义（P＜0.05）.输尿管软镜钬激光碎石术组术后住院天数（5.2±1.5）天,经皮肾镜碎石取石术组（8.4±1.6）天,差异有统计学意义（P＜0.05）.输尿管软镜钬激光碎石术组手术费用（1.5±0.2）万元,经皮肾镜碎石取石术组（1.1±0.1）万元,差异有统计学意义（P＜0.05）.结论 输尿管软镜钬激光碎石术比经皮肾镜碎石取石术有术中出血少、术后疼痛少、术后住院时间短、并发症少的优势,而在无石率、手术时间方面差异无统计学意义,对于1～2 cm的肾结石的手术治疗,首选输尿管软镜钬激光碎石术.

Objective To explore an appropriate treatment method for renal calculi comparing percutaneous nephrolithotomy and flexible ureteroscope holmium laser lithotripsy for 1-2 cm renal calculi.Methods 47 patients with unilateral renal calculi admitted into Changzhi People＇s Hospital from Match,2014 to Match,2015 were chosen.The diameter of the stones ranged from 1 to 2 cm.The patients were randomly divided into a percutaneous nephrolithotomy group （n=24） and a flexible ureteroscope holmium laser lithotripsy group （n=23）.The patient＇s age,sex,number of calculi,calculi size,operation time,calculi-free rate after surgery,bleeding volume,incidence of postoperative fever,postoperative pain,length of hospital stay,and surgical expenses were compared between these two groups.Results There were no statistical differences in age,gender,number of calculi,and calculi size between theses two groups （P 〉0.05）.The operation time was（57.9±13.4） min in the percutaneous nephrolithotomy group and was （54.3±12.9） min in the flexible ureteroscope holmium laser lithotripsy group,with no statistical difference（P 〈0.05）.2 cases were not calculi-free in the percutaneous nephrolithotomy group,with a clearance rate of 91.7%,and 3 in the flexible ureteroscope holmium laser lithotripsy group,with a clearance rate of 86.9%,with no statistical difference（P 〉0.05）.The bleeding volume was （76.1±17.2） ml in the percutaneous nephrolithotomy group and was （44.6±15.3） ml in the flexible ureteroscope holmium laser lithotripsy group,with a statistical difference （P 〈0.05）.The incidence of postoperative fever was 16.7%（4/24） in the percutaneous nephrolithotomy group and was 13.0%（3/23） in the flexible ureteroscope holmium laser lithotripsy group,with no statistical difference（P 〉0.05）.5 got postoperative pain in the percutaneous nephrolithotomy group and none in the flexible ureteroscope holmium laser lithotripsy group,with a statistical difference（P 〈0.05）.The length of hospital stay was （8.4±1.6） days in the percutaneous nephrolithotomy group and was （5.2±1.5） days in the flexible ureteroscope holmium laser lithotripsy group,with a statistical difference（P 〉0.05）.The surgery cost was （11±1） thousand yuan in the percutaneous nephrolithotomy group and was （15±2） in the flexible ureteroscope holmium laser lithotripsy group,with a statistical difference（P 〈0.05）.Conclusions The bleeding volume is smaller,the length of hospital stay shorter,and the incidences of postoperative pain and complications lower in percutaneous nephrolithotomy than in flexible ureteroscope holmium laser lithotripsy.There are no statistical differences in calculi-free rate and operation time between these two operations.Flexible ureteroscope holmium laser lithotripsy is the first choice for 1-2 cm renal calculi.