经皮肾镜碎石术与输尿管软镜碎石术治疗直径10～20mm肾下盏结石的疗效分析

Comparative study of percutaneous nephrolithotomy and flexible ureteroscope lithotripsy for lower-pole calculi with a diameter of 10-20mm

目的探讨经皮肾镜碎石术（PCNL）与输尿管软镜碎石术（FURL）治疗直径10～20mm肾下盏结石的临床疗效。方法回顾性分析我院2013年1月至2015年1月符合纳入标准的104例肾下盏结石患者的临床资料,其中PCNL组患者58例,FURL组患者46例,比较两组患者手术时间、术后白细胞升高值、术后住院时间、碎石成功率、术后血红蛋白下降值、高热发生率及术后止痛药使用率等指标的差异。结果两组患者在术后白细胞升高值、碎石成功率、术后止痛药使用率及高热发生率的比较差异均无统计学意义（P〉0.05）。PCNL组手术时间（52.88±16.12）min短于FURL组（85.48±15.10）min,PCNL组术后住院时间（6.12±1.17）d长于FURL组（3.50±0.62）d,PCNL组术后血红蛋白下降值（8.80±4.41）g/L大于FURL组（0.65±0.23）g/L,差异比较均具有统计学意义（P〈0.05）。结论经皮肾镜碎石术与输尿管软镜碎石术用于治疗直径10～20mm的肾下盏结石的总体疗效相当,但输尿管软镜碎石术创伤更小、术后住院时间更短,值得在临床推广应用。

Objective To investigate the therapeutic effect of percutaneous nephrolithotomy（PCNL）and flexible ureteroscope lithotripsy（FURL）for lower-pole（LP）calculi with a diameter of 10-20 mm.Methods Clinical data of 104 cases of LP calculi with a diameter of 10-20 mm who underwent operation during Jan.2013 and Jan.2015 were retrospectively analyzed.Of all cases,58 were treated with PCNL,and 46 with FURL.The clinical effects were compared,including operation time,value of white blood cell（WBC）increase after operation,hospitalization time after operation,stone clearance rate,haemoglobin（Hb）decrease after operation,incidence of postoperative high fever and usage of analgesics.Results There was no statistical significance in the value of WBC increase,stone clearance rate,usage of analgesics and incidence of postoperative high fever（P〈0.05）.The operation time for the PCNL group and FRUL group was（52.88±16.12）min and（85.48±15.10）min;the hospitalization time after operation was（6.12±1.17）day and（3.50±0.62）day;the Hb decrease after operation was（8.80±4.41）g/L and（0.65±0.23）g/L,respectively.There were significant differences between the two groups（all P〈0.05）.Conclusion The overall curative effects are similar for the two approaches.For selected patients,FURL has less trauma and shoter postoperative hospital stay,so it is worth clinical application.