输尿管软镜治疗肾结石与微创经皮肾穿刺取石的疗效比较

Comparison of Curative Effects of Ureteral Soft-microscope in the Treatment of Renal Calculi with Minimally Invasive Percutaneous Nephrolithotomy

目的比较输尿管软镜治疗肾结石与微创经皮肾穿刺取石的疗效。方法方便选取2015年3月—2017年2月该院收治的100例肾结石患者作为观察对象,按照单双号法分为对照组(n=50)和治疗组(n=50),对照组给予输尿管软镜治疗,治疗组给予微创经皮肾穿刺取石治疗,比较手术相关指标、结石清除效果、并发症情况。结果结石直径≤20 mm,对照组(92.9%)与治疗组(92.3%)结石清除率差异无统计学意义(χ~2=0.006 5,P=0.936 0),治疗组手术时间(48.7±12.0)min短于对照组(68.4±14.4)min,术中出血量(80.3±26.6)m L多于对照组(7.8±2.4)m L(t=7.431 4、19.194 6,P=0.000 0、0.000 0);结石直径>20 mm,治疗组结石清除率87.5%高于对照组59.1%,手术时间(60.9±8.4)min短于对照组(92.4±23.5)min,术中出血量(86.3±28.6)m L多于对照组(10.5±4.1)m L(χ~2=4.101 5、8.925 2、18.551 1,P=0.042 8、0.000 0、0.000 0);治疗组(12.0%)与对照组(8.0%)术后并发症发生率差异无统计学意义(χ~2=0.444 4,P=0.505 0);术后两组生活质量(95.3±5.2)分、(95.8±6.2)评分均高于术前(54.5±6.5)分、(54.6±6.6)分,但组间差异无统计学意义(t=0.076 3、0.436 9,P=0.939 3、0.663 1)。结论直径≤20 mm的肾结石首选输尿管软镜治疗,直径>20 mm的肾结石首选微创经皮肾穿刺取石术治疗。

Objective To compare the efficacy of ureteroscopy in the treatment of kidney stones and minimally invasive percutaneous nephrolithotomy. Methods A total of 100 patients with kidney stones who were treated in the hospital from March 2015 to February 2017 were convenient selected as observation subjects. The patients were divided into control group （n=50） and treatment group （n=50） according to the single and double number method. The ureter was treated with soft bronchoscope. The treatment group was treated with minimally invasive percutaneous nephrolithotomy. The surgical related indexes, stone removal effect and complications were compared. Results Stone diameter 420 ram,There was no sigificant difference in stone clearance between the control group （92.9%） and the treatment group （92.3%） （X2=0.0065, P=0.9360）. The operation time of the treatment group （48.7±12.0） thin was shorter than that of the control group （68.4±14.4） rain, intraoperative blood loss （80.3±26.6） mL was more than control group （7.8±2.4） mL （t=7.431 4, 19.194 6, P=0.000 0,0.000 0）; stone diameter〉20 mm, treatment group stone removal rate 87.5% was higher than the control group by 59.1%, the operation time（60.9±8.4） rain was shorter than the control group （92.4±23.5） min, and the intraoperative blood loss （86.3±28.6） mL was more than the control group （10.5±4.1） mL, （X2=4.101 5, 8.925 2, 18.551 1, P=0.042 8,0.000 0,0.000 0）; There was no significant difference in postoperative complication rate between the treatment group （12.0%） and the control group （8.0%） （X2=0.444 4, P=0.505 0）; The quality of life （95.3±5.2）points and （95.8±6.2） points of the two groups were higher than those before surgery （54.5±6.5）points and （54.6±6.6）points, but there was no statistical difference between the groups （t=0.076 3, 0.436 9, P=0.939 3, 0.663 1）. Conclusion The treatment of renal stones with diameter 420 mm is the first choice for treatment of soft ureters. Minimally invasive pereutaneous nephrolithotomy is the best choice for the treatment of renal stones with a diameter of 〉20 mm.