同期与分期单通道经皮肾镜取石术联合输尿管软镜钬激光碎石术治疗复杂性肾结石的对比研究

Comparative study of same period and staging period of minimally invasive percutaneous nephrolithotomy surgery combined with flexible ureteroscopy lithotripsy treatment of complex renal calculi

目的探讨同期与分期单通道经皮肾镜取石术联合输尿管软镜治疗复杂性肾结石的疗效及安全性。方法回顾性分析2014年1月至2018年7月经影像学确诊的复杂性肾结石患者60例,同期行单通道经皮肾镜联合输尿管软镜手术组(同期组)30例,分期行单通道皮肾镜取石术联合输尿管软镜组(分期组)30例,比较同期组与分期组患者结石清除率与残留率、住院时间、并发症等。结果60例复杂性肾结石患者手术顺利完成。同期组手术时间短于分期组[(161.9±19.2)min vs.(223.0±22.9)min,t=11.353,P=0.000],同期组住院日短于分期组[(8.5±1.5)d vs.(14.5±1.8)d,t=14.152,P=0.000],同期组住院总费用短于分期组(t=11.058,P=0.000)。同期组与分期组术后3个月结石比较差异无统计学意义[90.0%(27/30)vs.93.3%(28/30),P=0.500]。同期组与分期组术后并发症比较差异无统计学意义(χ2=0.098,P=0.754)。结论同期经皮肾镜取石术联合输尿管软镜治疗复杂性肾结石和分期手术相比没有明显增加手术并发症等风险,是安全、可行的,值得推广。

Objective To investigate the efficacy and safety of single-channel percutaneous nephrolithotomy combined with flexible ureteroscopy lithotripsy in the treatment of complex renal stones.Methods Retrospective analysis of sixty cases of complex renal calculi diagnosed by radiology from January 2014 to July 2018.One-channel percutaneous nephrolithotomy combined with flexible ureteroscopy lithotripsy was performed in 30 patients during the same period and in stages.The stone clearance rate,length of hospital stays,and complications were compared between patients in the same period and in the staging group.Results Sixty patients with complex kidney stones underwent surgery successfully.The operative time in the same period group was shorter than that in the staging group[(161.9±19.2)min vs.(223.0±22.9)min,t=11.353,P=0.000].The hospitalization period in the same period group was shorter than that in the staging group[(8.5±1.5)d vs.(14.5±1.8)d,t=14.152,P=0.000],the total cost of hospitalization in the same period was shorter than that of the staging group[(22186.9±1762.0)years vs.(33423.2±5464.5)years,t=11.058,P=0.000].There was no statistical difference in stones between the same period group and the three-month period of the staging group[90.0%(27/30)vs.93.3%(28/30),Fisher's exact test,P=0.500].There was no statistical difference in postoperative complications between the concomitant and staging groups[23.3%(7/30)vs.20.0%(6/30),χ2=0.098,P=0.754].Conclusions Carrying out minimally invasive percutaneous nephrolithotomy surgery combined with flexible ureteroscopy lithotripsy treatment for patients with complex renal calculi is feasible and safe.