肾盏结石手术治疗策略的选择

Surgical Treatment Strategies of Calyceal Calculi

目的对比分析不同手术方法治疗肾盏结石的临床疗效，为肾盏结石手术治疗策略选择提供依据。方法选取120例肾盏结石患者，随机分为经皮肾镜组和输尿管软镜组，比较两组患者不同结石直径的手术时间、取石成功率及术后并发症发生率。结果直径≥2cm（或表面积≥500mm2）的上盏、中盏、下盏结石经皮肾镜组手术时间较输尿管软镜组短（P〈0．05）；直径〈2cm（或表面积〈500mm2）的上盏、中盏结石输尿管软镜组手术时间较经皮肾镜组短（P〈0．05），直径〈2cm（或表面积〈500mm2）的下盏结石输尿管软镜组手术时间较经皮肾镜组长（P〈0．05）。直径≥2cm（或表面积≥500mm2）的上盏、中盏、下盏结石经皮肾镜组取石成功率均高于输尿管软镜组，差异具有统计学意义（P〈0．05）；直径〈2cm（或表面积〈500mm2）的上盏、中盏结石两组患者取石成功率差异无统计学意义（P〉0．05）；直径〈2cm（或表面积〈500mm2）的下盏结石经皮肾镜组取石成功率均高于输尿管软镜组（P〈0．05），两组患者术后并发症发生率差异无统计学意义（P〉0．05）。结论输尿管软镜碎石与经皮肾镜取石治疗肾盏结石各有利弊，术后并发症发生率均较低，临床上应根据患者实际情况选择合适的手术方法。

Objective To compare the clinical effects of different surgical methods in treating calyceal calculi in order to provide the basis for choosing surgical strategies. Methods 120 patients with calyceal calculi were randomly divided into percutaneous nephroscopy group and flexible ureteroscopy group. Operation time, success rate and postop- erative complication rate between the two groups were compared. Results The operation time of upper, middle and lower calyceal calculi with diameter≥2 cm（or surface area≥500 mm2） in percutaneous nephroscopy group was sig- nificantly shorter than that in flexible ureteroscopy group（ P 〈 0.05 ）. The operation time of upper and middle calyceal calculi with diameter 〈 2 cm （ or surface area 〈 500 mm2） in flexible ureteroscopy group was significantly shorter than that in percutaneous nephroscopy group（ P 〈 0.05 ）. The operation time of lower calyceal calculi with diameter 〈 2 cm （ or surface area 〈 500 mm2 ） in flexible ureteroscopy group was significantly longer than that in percutaneous nephros- copy group（ P 〈 0.05 ）. The success rate of upper, middle and lower calyceal calculi with diameter≥2 cm（ or surface area≥500 mm2） in percutaneous nephroscopy group was significantly higher than that in flexible ureteroscopy group （ P 〈 0. 05 ）. There was no significant difference in success rate of upper and middle calyceal calculi with diameter 〈 2 cm （ or surface area 〈 500 mm2 ） between the two groups （P 〉 0.05 ）. The success rate of lower calyceal calculi with diameter 〈 2 cm（ or surface area 〈 500 mm2） in percutaneous nephroscopy group was significantly higher than that in flexible ureteroscopy group（ P 〈 0.05 ）. There was no significant difference in postoperative complication rates between the two groups （ P 〉 0.05 ）. Conclusion There are pros and cons of the two methods. Postoperative complication rates are both low. The appropriate surgical strategies should be selected according to actual situation of patients.