逆行肾内手术与经皮肾镜治疗结石直径＞2cm肾结石的临床比较研究

Comparison of retrograde intrarenal surgery and percutaneous nephrolithotomy in the treatment of kidney stone greater than 2 cm

目的 比较逆行肾内手术（RIRS）与经皮肾镜（PCNL）治疗结石直径在2～4cm肾结石的临床疗效.方法 回顾性分析本院2009年10月至2014年10月期间收治的143例肾结石患者临床资料,其中86例行经皮肾镜手术（PCNL）治疗（男性53例,女性33例）,57例行RIRS治疗肾结石,结合术前和术后指标及参数,比较两种术式的术后并发症及结石清除率.结果 143例患者手术过程均顺利完成,两组患者在术前有无既往手术史、结石位置、结石平均直径、住院时间、术后血红蛋白改变方面有显著差异（P＜0.05）.RIRS手术组平均手术时间为（100.26±33.26） min,PCNL组平均手术时间为（75.55±21.5）min（P＜0.001）,两者有显著性差异;RIRS组平均住院时间明显短于PCNL组[（1.56±0.8）d vs（4.57±2.1）d,P＜0.001];RIRS组、PCNL组一期清石率分别为66.6％、91.8％（P＜0.05）,经二期治疗后RIRS组清石率可以达到87.7％;术后3个月随访清石率分别为92.5％、92.4％（P＞0.05）;PCNL组总体并发症率较RIRS组高,术后PCNL组两例患者需要输血治疗.结论 经皮肾镜术仍然是肾结石直径＞ 2cm的首要选择,但多期输尿管软镜术治疗2～4cm结石也可以达到PCNL同样的清石率,且并发症少,术前严格筛选病例,RIRS术治疗2～4cm结石在一定程度上可以代替PCNL治疗较大的结石,且可以达到满意的结果.

Objectives To evaluate the safety and efficacy of retrograde intrarenal surgery （RIRS） in the treatment of kidney stone with a diameter of 2 ～ 4 cm and to compare its results with those of percutaneous nephrolithotomy（PCNL）.Methods We retrospectively analyzed a total of 143 patients：86 patients （53 males and 33 females） who underwent PCNL and 57 patients （37 males and 20 females） who underwent RIRS between October 2009 and October 2014.Results The mean duration of operation was （100.26±33.26） min in the RIRS group and （75.55 ±21.5） min in the PCNL group（P 〈 0.001）.The hospital stay was significantly shorter in the RIRS group[（1.56 ± 0.8） d vs （4.57 ±2.1）d in the RIRS and PCNL group,respectively;P 〈0.001].Stone-free rates after one stage was 66.6% and 91.8% in the RIRS and PCNL groups,respectively.The stone-free rate of the RIRS group increased to 87.7% after the second stage.Blood transfusions were required in two patients in the PCNL group.Complication rates were higher in the PCNL group.Conclusions This study revealed that RIRS can be an alternative to PCNL in the treatment of kidney stone with a diameter of 2 ～4cm,especially in patients with comorbidities.