微创经皮肾镜与输尿管软镜治疗较大肾结石的疗效比较

Comparison between effects of micro-invasive percutaneous nephrolithotomy and flexible ureteroscope in treatment of larger kidney stones

目的比较微创经皮肾镜取石术与输尿管软镜钬激光碎石术治疗较大(2~4 cm)肾结石的疗效及安全性。方法回顾性分析本科治疗的137例较大肾结石患者临床资料,其中62例接受输尿管软镜钬激光碎石术治疗(FURS组),75例接受微创经皮肾镜取石术(mPCNL组)。比较两组手术情况、清石率及并发症的发生率。结果 FURS组术中出血及手术时间较mPCNL组显著降低(P<0.05);FURS组和mPCNL组结石清除率分别为79.03%和81.33%,差异无统计学意义(P>0.05);两组术后并发症发生率均较低,mPCNL组总发生率高于FURS组,但差异无统计学意义(P>0.05)。结论微创经皮肾镜取石术与输尿管软镜治疗2~4 cm肾结石均取得较理想的结石清除率,但FURS术中出血少,手术时间短,且术后严重肾出血及输血等并发症发生风险可能较mPCNL术低。

Objective To compare the effects and safety of micro-invasive percutaneous nephrolithotomy and flexible ureteroscope in the treatment of larger（2-4 cm） kidney stones. Methods The clinical data of 137 patients with larger kidney stones treated in our department were analyzed retrospectively. Among them, 62 ones（FURS group） were treated with ureteroscopic holmium laser lithotripsy and 75 ones（mPCNL group） with mini-percutaneous nephrolithotomy. The operation conditions, stone clearance rate and incidence of complications between the two groups were compared. Results The intraoperative amount of bleeding in FURS group was much less than that in mPCNL group（P 〈 0.05）; the stone clearance rate in FURS group and mPCNL group was 79.03% and 81.33% respectively,showing no statistical difference（P 〉 0.05）; the incidence of postoperative complications was low, but the incidence in mPCNL group was higher than that in FURS group, showing no statistical difference（P 〉0.05）. Conclusion Both mPCNL and FURS have ideal stone clearance rate in the treatment of 2-4 cm kidney stones, but FURS has less intraoperative amount of bleeding, shorter operation time,and lower incidence of renal hemorrhage, transfusion and other postoperative complications than mPCNL.