输尿管软镜碎石术与经皮肾镜碎石术治疗肾下盏结石的疗效对比

Comparison between retrograde intrarenal surgery and percutaneous nephrolithotomy in the treatment of lower-pole stones

目的探讨对于直径≤2.5 cm肾下盏结石的最佳微创治疗方法。方法回顾性分析2014年1月—2015年5月该科收治的单侧肾下盏结石81例临床资料和治疗方法。将患者随机分为两组,其中采用输尿管软镜碎石术(retrograde intrarenal surgery,RIRS)的患者为33例,采用经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)的患者为48例。比较两种手术方法治疗结石的手术时间、碎石成功率、手术前后血红蛋白下降值、术后住院天数、住院费用和并发症等,分析两种治疗方式的临床疗效。结果 RIRS组患者的结石直径为(18.9±3.4)mm,PCNL组患者的结石直径为(19.1±3.2)mm,组间比较差异无统计学意义(P>0.05)。RIRS组手术均顺利完成,术后发热2例,未出现严重的并发症;PCNL组手术均顺利完成,术后发热7例,术中术后明显出血2例,经选择性肾动脉栓塞治愈。一期清石率PCNL组为86.0%,RIRS组为82.3%,组间比较差异无统计学意义(P>0.05);PCNL组手术前后血红蛋白下降值为(16.9±8.9)g·L-1,RIRS组手术前后血红蛋白下降值为(4.7±1.6)g·L-1,手术时间分别为(94.0±17.1)、(117.9±25.1)min,住院天数分别为(9.6±2.4)d、(6.3±1.4)d,住院费用分别为(20 214±3 436.2)、(16 414±2 572.6)元,组间比较差异均有统计学意义(P<0.05)。结论对于直径≤2.5 cm的肾脏下盏结石,RIRS与PCNL疗效相近,而RIRS具有创伤小、住院天数少、并发症率低等优点,值得在临床推广使用。

Objective To compare the therapeutic effect of retrograde intrarenal surgery（RIRS）and percutaneous nephrolithotripsy （PCNL）in treating patients with renal calculi ≤2.5 cm.Methods Data of a total of 81 cases treated by either PCNL（48）or RIRS （33）from January 2014 to May 2015 were retrospectively analyzed.Operative time,stone free rate,postoperative hospital stay,hospital-ization expenses and complications were compared between the 2 groups.Results The stones of the RIRS group and PCNL group were （18.9 ±3.4）mm and （19.1 ±3.2）mm,respectively.There was no significant difference between the two groups.In RIRS group,op-erations were performed successfully in all 33 calculi.No serious complications was recorded except postoperative fever in 2 cases.In PCNL group,all patients had been successfully operated.Postoperative fever occurred in 7 cases.Obvious intraoperative and postopera-tive haemorrhage appeared in 2 cases,and cured by selective renal artery embolization.The operation time of the RIRS group and PCNL group was （117.9 ±25.1）min and （94.0 ±17.1）min respectively,with no significant difference between the two groups（P 〉0.05）. The stone free rates of the RIRS group and PCNL group were 86.0%and 82.3%respectively with no significant difference between the two groups（P 〉0.05）.Hemoglobin drop -out values of the RIRS group and PCNL group were （4.7 ±1.6）g·L^-1 and（16.9 ±8.9） g·L^-1 with a significant difference between the two groups（P 〈0.05）.Postoperative hospital stays of the RIRS group and PCNL group were （6.3 ±1.4）days and （9.6 ±2.4）days with a statistical difference between the two groups（P 〈0.05）.Hospitalization expenses of the RIRS group and PCNL group were （16 414 ±2 572.6）RMB and （20 214 ±3 436.2）RMB with a statistical difference between the two groups（P 〈0.05）.Conclusions Although RIRS and PCNL have similar curative effect in treating lower -pole renal stones of less than 2.5 cm,RIRS has the advantages of less trauma and fewer complications,lower expenses and shorter hospital stay, which is worthy of clinical application.