经皮肾镜及输尿管软镜治疗>2cm孤立肾结石的临床疗效比较

Comparison of percutaneous neprolithotomy and flexible ureteroscopy in the treatment of more than 2cm stones in a solitary kidney

目的比较经皮肾镜及输尿管软镜对>2cm孤立肾结石的治疗效果。方法回顾性分析我院2009年9月-2015年2月本院收治的28例>2cm孤立肾结石分别行经皮肾镜取石和输尿管软镜取石的患者临床资料,其中16例行经皮肾镜钬激光碎石术(经皮肾镜组),12例行输尿管钬激光碎石术(输尿管软镜组),对比住院时间、术后即刻HGB下降值、结石清除率,同时测定术后4周血清肌酐值。结果经皮肾镜组结石清除率为81.3%(13/16),输尿管软镜组结石清除率为75%(9/12),P>0.05;经皮肾经组术后即刻复查HGB下降值为(10.5±4.2)g/L,输尿管软镜组为(3.4±2.5)g/L,且差异有统计学意义;术后4周复查血清肌酐值,经皮肾镜组(79.8±27.5)μmol/L,输尿管软镜组(76.5±24.4)μmol/L,P>0.05。结论经皮肾镜及输尿管软镜治疗>2cm孤立肾结石均安全、有效,但相比经皮肾镜取石,输尿管软镜取石住院时间更短,出血更少。

Objective To compare the clinical effect of percutaneous neprolithotomy （PCNL） and flexible ureteroscopy in the treatment of more than 2cm stones in a solitary kidney. Methods From september 2009 to February 2015,28 cases of more than 2cm stones in a solitary kidney were treated by PCNL and flexible ureteroscopy in our hospital,of which 16 case were treated with PCNL（PCNL group）, and 12 cases with flexible ureteroscopy （Flexible ureteroscopy group） respectively. The length of stay, the HGB drop value after operation immediately,stone-free rate,and serum creatinine after operation four weeks were compared. Results The was no statistical differencein stone-free rate [81.3%（PCNL group） vs 75%（Flexible ureteroscopy group）,P〉0.05], the mean HGB drop value after operation immediately in PCNL group was （10.5±4.2）g/L, which more than of Flexible ureteroscopy group （3. 4±2.5）g/L,the difference was statistically significant. The mean serum creatinine after operation 4 weeks was （79.8±27.5）μmol/L （PCNL group）, （76.5 ±24.4） μmol/L （Flexible ureteroscopy group） , respectively. This difference was no statistically significant（P〈0. 05）. Conclusion Both PCNL and flexible ureteroscopy are effectively and safely,but compared with PCNL,flexible ureteroscopy have a shorter hospital stay and less bleeding.