经皮肾镜碎石取石术与输尿管软镜碎石术治疗直径>2cm孤立性肾结石的疗效对比

Comparison of percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of stones(>2cm) in patients with a solitary kidney

目的比较经皮肾镜碎石取石术(PCNL)与输尿管软镜碎石术(FURS)治疗孤立性肾结石(结石直径2.0-4.5 cm)的疗效差异。方法回顾性分析2012年8月至2018年5月本院收治的80例孤立性肾结石(结石直径2.0-4.5 cm)患者的临床资料,其中43例行PCNL术,37例行FURS术。比较两组患者的手术时间、术后住院时间、住院费用、术后血红蛋白下降水平、术后输血率、止血药使用率、术后发热和感染发生率、清石率,手术前后肾功能变化等指标。结果手术时间PCNL组比FURS组短(P=0.039);术后住院时间PCNL组比FURS组长(P<0.001);平均住院费用PCNL组高于FURS组(P<0.001);平均术后血红蛋白下降水平PCNL组多于FURS组(P=0.014);术后输血率PCNL组高于FURS组(P=0.01);PCNL组术后使用止血药有14例(32.5%),FURS组没有使用止血药的患者,差异具有统计学意义(P<0.001)。两组患者术后使用止痛药分别为11例(25.6%)和2例(5.4%)(P=0.015)。PCNL组术后7例出现发热,FURS组4例发热(P=0.479)。两组都没有出现尿源性脓毒血症的病例。一期清石率PCNL组(86%)高于FURS组(68%)(P=0.048),但总清石率两组差异无统计学意义(P=0.524)。PCNL组术后BUN水平下降(P=0.006),但Scr下降水平差异无统计学意义(P=0.089);FURS组手术前后Scr和BUN水平差异均无统计学意义(P>0.05)。结论孤立肾结石的治疗风险较大,PCNL和FURS均是治疗2.0-4.5cm孤立性肾结石的有效的方法,其中PCNL有更高的一期清石率,但FURS术后并发症更少、术后住院时间更短。

Objective To compare the clinical efficacy of percutaneous neprolithotomy ( PCNL) and flexible ureteroscopy (FURS) in the treatment of 2. 0 - 4 . 5 cm stones in a solitary kidney. Methods We retrospectively analyzed 80 cases of calculi in solitary kidney from August 2012 to May 2018, the sizes of the stones were 2. 0 -4 . 5 cm, 43 patients underwent PCNL and 37 patients underwent FURS. The patients characteristics, stone features, operative time, postoperative hospital stay, hospitalization cost, incidence complications, stone - free rate and renal functions have been evaluated. Results The clinical characteristic of the two groups were comparable. The operative time of PCNL group (103 ± 36) min was shorter than that of FURS group (120 ± 31 ) min ( P = 0. 039). The postoperative hospitalization stay of PCNL group (9. 7 ± 5. 1 ) d was longer than that of FURS group (2. 3 ± 1 .2 ) d ( P < 0 . 001). The average hospitalization expenses of the PCNL group (29796 ± 10054) yuan were higher than that of the FURS group ( 19320 ± 7546) yuan ( P < 0. 001 ). The mean postoperative hemoglobin level of PCNL group (9. 3 ± 14. 6) g /L was higher than that of FURS group (3 .3 ± 3 .6 )g /L ( P = 0.014). The postoperative blood transfusion rate of PCNL group was higher than that of FURS(P =0. 010). There were 14 cases (32. 5%) in the PCNL group using hemostatics after surgery, whereas there was nobody use hemostatics in FURS group, which was statistically significant( P <0. 001 ). Eleven patients ( 25. 6%) and 2 patients (5 .4 %) of postoperative were treated with pain reliever(P =0. 015). There were 7 patients have fever in PCNL group and 4 cases in FURS group ( P = 0. 479 ). There were no cases of urinary sepsis in either group. The rate of one - session stone removal of PCNL group (86%) was higher than that of FURS (68%)( P = 0. 048), but there was no significant difference between the two groups in total stone removal rate(P =0. 524). Both the levels of serum creatine ( Scr) and BUN in the PCNL group decreased after surgery, but only the change of BUN level had statistically significant( P =0. 006). There was no statistically significant in the FURS group( P > 0. 05). Conclusions Both percutaneous nephrolithotomy and flexible ureteroscopy are effective methods for 2. 0 -4 . 5 cm stones in a solitary kidney, PCNL has a higher rate of the stone - free rate than FURS, but FURS has less complications, and shorter postoperative hospital stay.