软性输尿管镜及经皮肾镜术式治疗肾结石的疗效及安全性比较

Efficacy and safety of flexible ureter mirror and percutaneous renal lithotripsy in patients with renal calculi

目的对比研究软性输尿管镜(FURS)与经皮肾经术式(PCNL)治疗肾结石的疗效以及安全性。方法选择2013年7月至2015年8月接受治疗的肾结石病患94例,以数字法随机分为观察组和对照组,各47例。观察组采用FURS治疗,对照组采用PCNL治疗。对比两组患者的手术时间、住院时间以及住院费用,计算清石率以及术后术后感染、出血、发热的发生率等。结果观察组手术时间高于对照组,但住院时间以及住院费用显著低于对照组;两组结石直径<20 cm的清石率相差不大,而观察组在结石直径≥20 cm以及总体清石率为53.33%(8/15)、72.34%(34/47),均显著低于对照组的88.24%(15/17)、91.49%(43/47);观察组治疗后出现术后感染、术后出血以及发热的发生率均显著低于对照组;且两组治疗前血红蛋白、血肌酐水平对比无差异,治疗后观察组血红蛋白、血肌酐水平显著低于对照组,差异均有统计学意义(均P<0.05)。结论 FURS和PCNL对肾结石患者均有较好的治疗效果,相对而言FURS治疗后恢复时间更短,并发症更少,而PCNL清石率更高。

Objective To explore the efficacy and safety flexible ureteroscope （FURS） and percutaneous kidney surgery （PCNL） on treatment of patients with renal stone disease. Methods 94 cases of patients with kidney stones in our hospital from July 2013 to August 2015 were selected and randomly divided into observation group and controt group with 47 cases in each group. Observation group was treated with FURS therapy, the control group with PCNL. The operative time, length of stay and hospital costs, calculate stone clearance rate and postoperative post-operative infection, bleeding, fever incidence, etc. was compared in the two groups. Results The operation time of the observation group was higher than that of the control group, but the length of stay and hospital costs were significantly lower than those of the contruI group. The stone clearance rate between the two groups with stone diameter less than 20 cm had no difference, but in the observation group with the stones larger than 20 cm in diameter and the overall stone clearance rate was 53.33% （8/15）, 72.34% （34/47）, were significantly lower than those in the control group 88.24% （15/17）, 91.49% （43/47）. After treatment, postoperative infection, postoperative bleeding and fever of proportion in the observation group was significantly lower than that in control group respectively. Hemoglobin, serum creatinine level between the two groups before treatment had no significant difference, but after the treatment, hemoglobin, serum creatinine level in the observation group was significantly lower than that of the control group, with significant difference （ P 〈 0.05 ）. Conclusion FURS and PCNL in patients with renal stone disease has a better therapeutic effect. FURS treatment can shorten the recovery time with fewer complications, but stone clearance rate of PCNL is higher.