经皮肾镜碎石术联合输尿管软镜碎石术治疗≥2cm肾下盏结石的疗效观察

The Curative Effect Observation of Percutaneous Nephrolithotomy Combined with Flexible Ureteroscope Lithotripsy in the Treatment of the ≥2cm Stones in the Lower Kidney Calyx

目的探讨经皮肾镜碎石术(PCNL)联合输尿管软镜碎石术(fURL)处理≥2cm肾下盏结石的安全性和有效性。方法选取2014年6月至2016年11月因肾下盏结石于成都医学院第一附属医院行PCNL联合fURL或仅行PCNL手术的59例患者为研究对象,根据采用手术方式的不同分为PCNL联合fURL组(n=30)和PCNL组(n=29)。比较两组患者在手术时间、住院时间、手术并发症发生率、血红蛋白下降量和结石清石率方面的差异。结果两组患者在年龄、结石大小和性别方面比较,差异无统计学意义(P>0.05)。PCNL联合fURL组和PCNL组在一期结石清除率(93.3%、72.4%),手术时间(115.75±16.13)min、(68.78±11.50)min和住院时间(13.40±0.76)d、(9.60±1.13)d等结局指标方面比较,差异均有统计学意义(P<0.05)。在术后血红蛋白下降值(8.50±0.73)g·L-1、(7.20±0.21)g·L-1)和并发症发生率(16.7%、10.3%)方面比较,差异无统计学意义(P>0.05)。结论 PCNL联合fURL治疗≥2cm肾下盏结石具有创伤小、并发症少、结石清除率高等优点,安全、有效,值得临床推广应用。

Objective To explore the efficacy and safety of percutaneous nephrolithotomy(PCNL)combined with flexible ureteroscope lithtripsy(fURL)in the treatment of the≥2cm stones in the lower kidney calyx.Methods59patients with lower calyx calculi undergoing PCNL combined with fURL or fURL only in The First Affiliated Hospital of Chengdu Medical College from June of2014to November of2016were selected and divided into the PCNL and fURL group(n=30)and the PCNL group(n=29)according to the operation methods.The two groups were compared in terms of the surgery time,length of hospital stay,complication rate,decrease of hemoglobin and stone clearance rate.Results There were no significant differences in the age and gender of patients and the size of stones between the two groups(P>0.05).As to the outcome indicators,the stone clearance rate of Stage I,surgery time,and length of hospital stay were93.3%,(115.75±16.13)min,and(13.40±0.76)d respectively in the PCNL and fURL group and72.4%,(68.78+11.50)min,and(9.60±1.13)d respectively in the fURL group,and the differences were statistically significant between the two groups(P<0.05).The hemoglobin decreased by(8.50±0.73)g·L-1in the PCNL and fURL group and(7.20±0.21)g·L-1in the fURL group and the complication rate was16.7%in the PCNL and fURL group and10.3%in the fURL group,and the differences were not statistically significant(P>0.05).Conclusion PCNL combined with fURL is safe and effective with less traumas and complications and high stone clearance rate in the treatment of the≥2cm stones in the lower kidney calyx,so it is worth the clinical popularization.