经皮肾镜碎石术联合顺行和逆行输尿管软镜治疗复杂性肾结石的临床研究

Clinical study of percutaneous nephrolithotomy combined with anterograde or retrograde flexible ureteroscopy in the treatment of complex renal calculi

目的比较单通道同期经皮肾镜联合顺行输尿管软镜及经尿道逆行输尿管软镜治疗复杂性肾结石的可行性及临床效果。方法回顾性分析2014年10月至2017年10月陕西省人民医院泌尿外科收治的84例复杂性肾结石患者的临床诊治资料,所有患者均给予单通道微创经皮肾镜联合顺行或逆行输尿管软镜治疗,其中行顺行手术44例(顺行组),逆行手术40例(逆行组),比较两组患者的手术时间、住院时间、结石清除率以及术后并发症的差异。结果顺行组患者的手术时间为(119.2±30.2) min,短于逆行组的(151.7±47.5) min,一期结石清除率为70.5%,低于逆行组的90.0%,差异均有统计学意义(P<0.05);顺行组和逆行组患者的住院时间分别为(7.5±2.0) d、(8.1±3.1) d,血红蛋白变化值分别(15.3±4.6) g/L和(14.8±4.0) g/L,手术并发症发生率分别为15.9%和15.0%,差异均无统计学意义(P>0.05);顺行组患者的住院费用为(2.5±0.6)万元,低于逆行组的(2.9±0.8)万元,差异有统计学意义(P<0.05)。结论对于复杂性结石,单通道同期微通道经皮肾镜联合输尿管软镜治疗是安全有效的。经皮肾镜联合顺行输尿管软镜治疗复杂性肾结石较为直接且费用较低,而联合逆行输尿管软镜治疗复杂性肾结石更为有效,但手术时间较长和费用较高,应根据患者具体情况决定手术方式。

Objective To compare the feasibility and clinical effects of single channel simultaneous percutaneous nephrolithotomy combined with anterograde or retrograde flexible ureteroscopy in the treatment of complex renal calculi. Methods A retrospective analysis was made of the clinical data of 84 patients with complicated renal calculi admitted to Department of Urology, Shaanxi Provincial People’s Hospital from October 2014 to October 2017. All patients were treated with single-channel minimally invasive percutaneous nephroscopy combined with antegrade or retrograde flexible ureteroscopy. Among them, 44 patients underwent antegrade surgery and 40 patients underwent retrograde surgery. The operation time and residence of the two groups were compared. The operation time, hospitalization time, stone clearance rate and postoperative complications were compared. Results The operation time of the anterograde group was(119.2±30.2) min, which was significantly shorter than(151.7±47.5) min of the retrograde group;the stone clearance rate was 70.5%, which was significantly lower than 90.0% of retrograde group(all P<0.05). The hospitalization time of the anterograde group and retrograde group were(7.5±2.0) d,(8.1±3.1) d, and the hemoglobin changes were(15.3±4.6) g/L and(14.8±4.0) g/L, respectively;the operative complications were 15.9% and 15.0% respectively(all P>0.05). The hospitalization cost of the antegrade group was(2.5 ± 0.6) million yuan, which was significantly lower than(2.9±0.8) million yuan of the retrograde group(P<0.05). Conclusion Single channel simultaneous percutaneous nephrolithotomy combined with flexible ureteroscopy is safe and effective in the treatment of complex renal calculi. The combination of percutaneous nephroscope and anterograde flexible ureteroscopy for the treatment of complicated renal calculi is more direct, and the combination of retrograde ureteroscopy is more effective in the treatment of complicated renal calculi. However, the operation time of the combination of retrograde ureteroscopy is longer than anterograde combination. Thus, the operation method should be determined according to the patient’s specific conditions.