输尿管软镜钬激光治疗大于2cm肾盏结石的疗效及安全性评价

Curative effects and safety of holmium laser and ureter mirror for renal calyx calculi larger than 2 cm

目的:探讨输尿管软镜钬激光治疗大于2cm肾盏结石的疗效及安全性。方法:选择本院的肾盏结石患者48例,随机分为观察组26例和对照组22例,观察组给予输尿管软镜碎石术(FURL)治疗,对照组给予皮肾镜碎石(PCNL)治疗;对比两组手术时间、碎石能量、术后3个月治疗有效率、术后住院时间以及患者术前、术后的4、24、48、72h的血NGAL和尿KIM-1浓度的变化和并发症情况。结果:两组治疗有效率、手术时间及碎石能量之间比较,差异无统计学意义(P>0.05);观察组的术后住院时间较对照组的短,差异具有统计学意义(P<0.05);两组术后4h及24h血NGAL及尿KIM-1较术前高,组内差异有计学意义(P<0.05);但观察组较对照组的低,差异有统计学意义(P<0.05);观察组发热率较对照组的高,差异有统计学意义(P<0.05);两组总的并发症发生率、大出血、感染及石街发生率之间比较,差异无统计学意义(P>0.05)。结论:PCNL及FURL治疗>2cm的肾盏结石总体疗效相近,但FURL治疗对肾损伤较小,术后住院时间较短,值得在临床合理选择应用。

Objective.. To investigate the curative effects and safety of holmium laser and ureter mirror for renal calyx calculi larger than 2 cm. Methods.. A total of 48 patients with renal calyx calculi were randomly divided into observation group （26 cases） and control group （22 cases）. The observation group was treated with ureter mirror lithotripsy （FURL） and control group was treated by skin nephroscope lithotripsy （PCNL）. Operation time, lithotripsy energy, efficiency, hospital stay and changes in blood NGAL and urine KIM - 1 concentration as well as incidence of complications were observed and compared between the two groups. Results： No significant difference in treatment efficiency, operation time, and lithotripsy energy was observed between the two groups （P〉0.05）. Length of hospital stay of the observation group was significant shorter than that of the control group （P〈0.05）. 4 h and 24 h after treatment, blood NGAL and urine KIM - 1 concentrations were both significant higher than that before treatment, but the increase was more obvious in the observation group （P〈0.05）. No significant difference in complications, blood loss, infection, steinstrasse was observed between the two groups （P〉0.05）. Conclusion： PCNL and FURL show similar curative effects and safety on renal calyx calculi larger than 2 cm, but FURL cause less damage on kidney, require shorter length of hospital stay. Ifs worthy of clinical application.