经皮肾镜和输尿管软镜治疗肾结石的疗效比较

Comparison of the effect between percutaneous nephrolithotomy and flexible ureteroscope lithtripsy in the treatment of renal calculus

目的:比较经皮肾镜(PCNL)和组合式输尿管软镜(FURS)治疗肾结石的疗效与并发症发生率。方法:将肾结石患者178例分为PCNL组94例和FURS组84例。按结石大小又将PCNL组分为结石>20 mm组51例,≤20 mm组43例;FURS组分为结石>20 mm组43例,≤20 mm组41例。比较2组的一般资料、手术时间、碎石时间、出血量、术后感染、并发症发生率、二期手术或ESWL术发生率、术后1周清石率、术后1个月清石率。结果:178例患者手术均成功。2组患者年龄、结石直径和结石部位差异均无统计学意义(P>0.05)。PCNL组的手术时间及碎石时间均明显短于FURS组(P<0.01)。PCNL组的术中出血量及术后出血率均明显多于FURS组(P<0.01)。PCNL组的术后感染率低于FURS组(P<0.05)。PCNL组的住院时间明显长于FURS组(P<0.01)。PCNL组术后1周的清石率高于FURS组(P<0.05)。当结石≤20 mm,PCNL组与FURS组中术后1个月清石率及二期手术或ESWL术的发生率差异均无统计学意义(P>0.05)。当结石>20 mm,PCNL组术后1个月清石率高于FURS组(P<0.05),PCNL组二期手术或ESWL术的发生率低于FURS组(P<0.05)。结论:PCNL术与FURS均是治疗肾结石的有效方法。PCNL清石率高,术后感染率低,尤其适用于直径>20 mm的肾结石。FURS具有微创性,术后恢复快,尤其适用于直径≤20 mm的肾结石患者。对于肾多发性结石和鹿角形肾结石可联合PCNL、FURS协同治疗提高临床疗效。

Objective： To compare the efficacy and incidence of complications between percutaneous nephrolithotomy （PCNL） and flexible ureteroscope lithtripsy（FURS） in the treatment the renal calculus. Methods：One hundred and seventy-eight patients with renal calculus were divided into the PCNL group（94 cases） and FURS group （84 cases）. According to the diameter of stone, the PCNL group were subdivided into the renal stone more than 20 mm group（51 cases） and renal stone less than or equal to 20 mm group（43 cases）, and the FURS group were subdivided into the renal stone more than 20 mm group（43 cases） and renal stone less than or equal to 20 mm group （41 cases ）. The general data, operating time, amount of bleeding, postoperative infection, postoperative complication, incidence of two-stage operation or ESWL and clearance stone rate at postoperative 1 week and 1 mouth between two groups were compared. Results： All operations were successful. The differences of the age, stone diameter and location between two groups were not statistically significant（P 〉 O. 05 ）. The time of operation and crushing stone, and postoperative infection rate in PCNL group were shorter than those in FURS group（P 〈 0.01 and P 〈0.05）. The postoperative hospitalization stay in PCNL group was longer than that in FURS group （P 〈 O. O1 ）. The clearance stone rate in PCNL group after 1 week of operation was higher than that in FURS group （P 〈 0.05）. In those patients with the stone diameter less than 20 mm,the differences of the clearance stone rate at postoperative one month and occurrence of the second stage operation or ESWL between PCNL and FURS group were not statistically significant （P 〉 0.05 ）. In those patients with the stone diameter more than or equal to 20 ram,the clearance stone rate at postoperative one month in PCNL group was higher than that in FURS group （P 〈 0.05）, and the occurrence of the second stage operation or ESWL in PCNL was lower than that in FURS group（ P 〈 0.05 ）. Conclnsions：The PCNL and FURS are effective methods in the treatment of renal calculus. The PCNL is high clearance stone rate and low infection rate, especially for the patients with the stone diameter more than 20 mm. The FURS is minimally invasive and quick recovery, especially for the patients with the stone diameter less than 20 mm. The treatment of patients with multiple renal calculus and staghorn calculus with PCNL combined with FURS can improve the clinical efficacy.