分期输尿管软镜与微创经皮肾镜治疗2～4cm肾盂结石的随机对照研究

A Comparison Between Staged Flexible Ureteroscopic Lithotripsy and Minimally Invasive Percutaneous Nephrolithotomy for Pelvis Stones 2-4 cm in Diameter: a Randomized Controlled Study

目的：比较分期输尿管软镜钬激光碎石术（ flexible ureteroscopic lithotripsy ， FURSL ）与微创经皮肾镜碎石术（minimally invasive percutaneous nephrolithotomy ，MPCNL）治疗2～4 cm肾盂结石的临床疗效和安全性。方法选取我院2013年1月～2015年12月收治的符合纳入标准的肾结石患者70例，随机分为分期FURSL和MPCNL组，每组35例。比较2组总术后住院时间、总治疗费用、手术前后血红蛋白下降值、结石完全清除率和并发症发生率。结果分期FURSL组结石完全清除率（65．7％，23／35）明显低于MPCNL组（94．3％，33／35）（χ^2＝8．929，P＝0．003）。分期FURSL组并发症发生率（5.7％，2／35）与MPCNL组（8．6％，3／35）差异无统计学意义（χ^2＝0．000，P＝1．000）。分期FURSL组手术前后血红蛋白下降值[（3．37±1．56）g／L]明显低于MPCNL组[（11．93±2．24）g／L]（t＝－18．231，P＝0．000）；分期FURSL组术后总住院时间[（3．7±1．3）d]明显短于MPCNL组[（5．1±0．4）d]（t＝－6．089，P＝0．000）。分期FURSL组总治疗费用[（5．43±0．61）万元]明显高于MPCNL组[（2．35±0．23）万元]（t＝27．951，P＝0．000）。结论在目前的技术条件下，分期FURSL治疗2～4 cm肾盂结石的临床疗效和安全性与MPCNL相当，但由于需要分次治疗和较长治疗时间，其治疗效率低于MPCNL。

Objective To compare the efficacy and safety between staged flexible ureteroscopic lithotripsy （ FURSL ） and minimally invasive percutaneous nephrolithotomy （MPCNL） in the treatment of pelvis stones 2-4 cm in diameter. Methods The study comprised of a total of 70 patients with kidney pelvic stones （2-4 cm） in our hospital between January 2013 and December 2015.The patients were randomly allocated to two groups as staged FURSL group （35 cases） and MPCNL group （35 cases）. Comparisons between the two groups were made with respect to total length of hospital stay after procedure , total medical costs , decrease in hemoglobin level , complete stone free rate and complication rate . Results The complete stone free rate in the staged FURSL group [65.7%（23/35）] was lower than the MPCNL group [94.3%（33/35）] （χ2 =8.929, P=0.003）.The complication rates in the staged FURSL group [5.7%（2/35）] and the MPCNL group [8.6% （3/35）] were not statistically significant （χ^2 =0.000, P=1.000）.The average drop in hemoglobin level in the staged FURSL group [（3.37 ±1.56） g/L] was less than the MPCNL group [（11.93 ±2.24） g/L] （t=-18.231, P=0.000）.The mean total length of hospital stay after procedure in the staged FURSL group [（3.7 ±1.3） days] was shorter than the MPCNL group [（5.1 ±0.4） days〗（t=-6.089, P=0.000）.The mean total hospitalization costs in the staged FURSL group [（5.43 ±0.61） ×10^4 yuan] were higher than the MPCNL group [（2.35 ± 0.23） ×10^4 yuan] （t=27.951, P=0.000）. Conclusion Although current technology with staged FURSL is effective on large kidney pelvis stones 2-4 cm in diameter , it has no superiority to MPCNL due to the need for multiple sessions and long treatment time .