采用软性输尿管镜术及经皮肾镜取石术治疗肥胖患者肾下盏结石的疗效分析

The treatment of renal lower pole calculi with flexible ureteroscope and percutaneous nephrolithotomy in obese patients

目的 探讨软性输尿管镜术（flexible ureteroscopy,FURS）治疗肥胖患者肾下盏结石的有效性及安全性.方法 回顾性分析2012年10月至2017年5月本院184例肾下盏结石肥胖患者（BMI≥30）的临床资料,根据手术方法分为FURS组和经皮肾镜（percutaneous nephrolithotomy,PNL）组,FURS组65例,PNL组119例.结石最大径FURS组和PNL组分别为（15.8±5.7）mm,（18.6 4.9） mm,两组患者均术后4周拔除双J管并复查超声或KUB,评估清石率及术后并发症情况.结果 FURS组和PNL组手术时间分别为（69.8±23.7）、（71.3±16.4）min,分别有57例和107例无残留结石（清石率87.69％与89.92％）,两组差异均无统计学意义（P＞0.05）.FURS组和PNL组分别有8例和12例有临床意义残留结石,经过主动排石治疗1个月后复查均消失.FURS组1例发热,8例腰痛,无肾周血肿.PNL组2例发热,23例腰痛,1例肾周血肿.FURS组术后VAS疼痛评分（3.3±1.1）分低于PNL组（5.6±0.9）分,住院时间（3.7 ±0.6）d短于PNL组（5.4 ±0.8）d,差异均有统计学意义（P＜0.05）.结论 FURS是一种治疗肥胖患者肾下盏结石的安全有效方式.

Objective To evaluate the efficacy and safety of flexible ureteroscopy （FURS） for the treatment of renal lower pole calculi in obese patients.Methods From October 2012 to May 2017,a total number of 184 obese patients（body mass index,BMI≥30） with lower pole kidney stones were randomly divided into two groups,FURS group （n =65） and percutaneous nephrolithotomy （PNL） group （n =119）.The mean stone size was （15.8 ± 5.7） mm in FURS group and （18.6 ± 4.9） mm in PNL group.Results All of the D-J stents were removed 4 weeks after operation in both groups,and ultrasonic or X-Ray 87.69% vs.89.92% （P 〉 0.05）.Residual stones were found in 8 vs.12 patients in each group,and all disappeared after active lithagogue treatment with external physical vibra tion lithecbole （EPVL）.Complications in FURS group were lower than PNL group,including fever（1 vs.2）,pain（8 vs.23）,perirenal hematoma（none vs.1）,the visual analogue scale/score（3.3 ± 1.1） vs.（5.6 ± 0.9） and hospital stay （3.7 ± 0.6） d vs.（5.4 ± 0.8） d was also lower（P 〈 0.05）.Conclusions FURS is a safe and efficient option for renal lower pole calculi in obese patients.