肾外型肾盂结石两种微创术式的临床特征比较

Comparison between two minimally invasive surgical treatment of extrarenal pyelolith

目的比较肾外型肾盂结石患者采用后腹腔镜肾盂切开取石术(RPL)和经皮肾镜取石术(PCNL)治疗的有效性和安全性。方法回顾分析2016年1月至2019年6月在武警安徽省总队医院泌尿外科接受RPL和PCNL的肾外型肾盂结石患者临床资料,分别有36例和41例纳入研究。比较2组患者手术成功率、手术时间、术中出血量、手术前后血红蛋白下降值、结石完全清除率、术后平均住院天数、总治疗费用和并发症等临床特征。结果RPL组有34例手术成功,2例中转开放手术。PCNL组手术均成功。RPL组和PCNL组比较,平均手术时间[(99.0±4.7)min vs.(95.0±5.1)min,P>0.05];术中出血量[(35.0±4.0)mL vs.(120.3±18.9)mL,P<0.05];手术前后血红蛋白下降值[(0.5±0.1)g/L vs.(1.5±0.5)g/L,P<0.05];结石完全清除率[100%vs.(85.4%,35/41),P<0.05];术后平均住院天数[(8.3±0.7)d vs.(6.9±0.7)d,P>0.05];总治疗费用[(1.4±0.2)万元vs.(1.94±0.3)万元,P<0.05]。2组比较,术中出血量、手术前后血红蛋白下降值、结石完全清除率、总治疗费用差异有统计学意义。平均手术时间、术后平均住院天数差异无统计学意义。结论较之PCNL,RPL治疗肾外型肾盂结石更为安全有效,费用相对低廉,在减少术中、术后出血或严重感染上有积极作用,可同时处理合并的解剖畸形,推荐作为优先选择的微创手术方式。

Objective To compare the efficacy and safety of retroperitoneoscopic pyelo-lithotomy(RPL)and percutaneous nephrolithotomy(PCNL)in the treatment of extrarenal pyelolith.Methods Clinical data of patients with extrarenal pyelolith treated during Jan.2016 and June 2019in our hospital were retrospectively analyzed,including 36 cases treated with RPL and 41 cases treated with PCNL.The surgical success rate,operation time,intraoperative blood loss,changes of hemoglobin after surgery,stone clearance rate,average postoperative hospital stay,total treatment costs and complications were compared between the two groups.Results In the RPL group,34 operations were successful and 2 cases converted to open surgery.In the PCNL group,all operations were successful.Between the RPL and PCNL groups,there were significant differences in intraoperative blood loss[(35.0±4.0)mL vs.(120.3±18.9)mL,P<0.05],change of hemoglobin after surgery[(0.5±0.1)g/L vs.(1.5±0.5)g/L,P<0.05],stone clearance rate[100%vs.85.4%,P<0.05],and total treatment costs[(14000±2000)yuan vs.(19400±3000)yuan,P<0.05],while there were no differences in the mean operation time[(99.0±4.7)min vs.(95.0±5.1)min,P>0.05]and average postoperative hospital stay[(8.3±0.7)d vs.(6.9±0.7)d,P>0.05].Conclusion Compared with PCNL,RPL is safer and more effective in the treatment of extrarenal pyelolith,with advantages of lower medical costs and less blood loss or severe infection.Meanwhile,anatomical deformities can be handled simultaneously.RPL is recommended as a preferred minimally invasive surgical treatment for extrarenal pyelolith.