经皮肾镜与经尿道输尿管软镜碎石术治疗单侧肾结石临床对比研究

Clinical comparative study of percutaneous nephrolithotomy and transurethral ureteroscopic lithotripsy in the treatment of unilateral renal calculi

目的微创腔镜手术近年来被广泛用于泌尿系统结石治疗,并取得令人满意效果;但在术式选择方面仍存在一定争议,本研究旨在探讨经皮肾镜与经尿道输尿管软镜碎石术治疗单侧肾结石临床疗效及安全性差异,为手术方案选择积累更多循证医学证据。方法选取2015-02-01-2017-02-01洛阳市中心医院收治的130例单侧肾结石患者作为研究对象,根据患者意愿分为A组(71例)和B组(59例),A组采用经皮肾镜碎石术治疗,B组采用经尿道输尿管软镜碎石术治疗;比较两组结石彻底清除率、手术用时、术后下床活动时间、术后血红蛋白(hemoglobin,Hb)下降值、住院时间及术后并发症发生率。结果两组结石彻底清除率分别为91.55%和89.83%,差异无统计学意义,χ~2=0.89,P=0.67;B组手术用时为(90.15±19.31)min,长于A组的(63.33±7.80)min,t=3.61,P<0.01;B组术后下床活动时间为(6.45±1.17)d,短于A组的(12.24±2.83)d,t=3.89,P<0.01;B组术后Hb下降值为(2.95±0.47)g/L,低于A组的(7.24±0.93)g/L,t=4.53,P<0.01;B组住院时间为(3.10±0.76)d,短于A组的(6.63±1.22)d,t=4.17,P<0.01。两组术后并发症发生率比较,差异无统计学意义,χ~2=1.16,P=0.51。结论经皮肾镜与经尿道输尿管软镜碎石术治疗单侧肾结石结石清除效果和安全性相近;经尿道输尿管软镜碎石术应用可有效降低术中医源性创伤程度,加快术后康复进程。

OBJECTIVE Minimally invasive laparoscopic lithotripsy has been widely used in the treatment of urinary calculi in recent years and has achieved satisfactory results.However,there is still some controversy in the choice of surgical methods.The purpose of this study is to investigate the clinical efficacy and safety of percutaneous nephrolithotomy and transurethral ureteroscopic lithotripsy in the treatment of unilateral renal calculi.METHODS A total of 130 patients with unilateral renal calculi admitted to Luoyang Central Hospital from February 1,2015 to February 1,2017 were divided into group A(71 cases)and group B(59 cases)according to their wishes.Percutaneous nephrolithotomy was used in group A and transurethral lithotripsy was used in group B.The stone clearance rate,operation time,postoperative ambulation time,postoperative hemoglobin(Hb)decline,hospital stay and postoperative complications were compared between the two groups.RESULTS There was no significant difference in stone clearance rate between the two groups,χ^2=0.89,P=0.67;Operation time in group B was(90.15±19.31)min,longer than that in group A(63.33±7.80)min,t=3.61,P<0.01.Postoperative ambulation time in group B was(6.45±1.17)d,shorter than that in group A(12.24±2.83)d,t=3.89,P<0.01.The decrease of Hb in group B was(2.95±0.47)g/L,lower than that in group A(7.24±0.93)g/L,t=4.53,P<0.01.The hospitalization time in group B was(3.10±0.76)d,shorter than that in group A(6.63±1.22)d,t=4.17,P<0.01.There was no significant difference in the incidence of postoperative complications between the two groups,χ^2=1.16,P=0.51.CONCLUSIONS Percutaneous nephrolithotomy and ureteroscopy lithotripsy in the treatment of unilateral renal calculi possess the same stone removal effects and safety.Ureteroscopy lithotripsy application can efficiently reduce the intraoperative trauma degree and promote the process after operation.