比较输尿管软镜联合钬激光碎石术和冲击波碎石术治疗1~2 cm复杂型肾下盏结石的疗效

Comparison of the efficacy of FURSL and SWL in the treatment of 1~2 cm complex subchondral calculi

目的比较铂立组合式输尿管软镜联合钬激光碎石术(FURSL)和冲击波碎石术(SWL)治疗对1~2 cm复杂型肾下盏结石的疗效。方法回顾性分析2014年2月至2017年7月在本院收治的复杂型肾下盏结石患者的临床资料,纳入35例接受FURSL治疗患者(FURSL组)和60例接受SWL治疗患者(SWL组)。比较两组的再治疗率、并发症率、无结石率(SFR)、二次手术、总手术次数及手术时间。结果与SWL组相比,FURSL组的再治疗率(8.6%vs.60.0%,P<0.001)、手术时间[(73.2±29.3)min vs.(92.3±40.8)min,P=0.017]和手术次数[(1.11±0.32)次vs.(2.23±1.14)次,P<0.001]均显著降低,并且FURSL组在3个月的SFR显著增加(66.7%vs.86.7%,P=0.036)。FURSL组患者的并发症发生率更高(11.4%vs.5.0%),但差异无统计学意义(P=0.144)。结论对于长度为1~2 cm的复杂型肾下盏结石的治疗,FURSL较SWL能够显著提供更高的SFR和更低的再治疗率,FURSL可作为治疗下极肾结石的有价值替代方案。

Objective To compare the efficacy of flexible ureteroscopy and lasertripsy(FURSL)and shockwave lithotripsy(SWL)in the treatment of 1~2 cm complex renal calyx calcul.Methods A retrospective analysis of the medical records of patients with complicated inferior calculi who underwent treatment from February 2014 to July 2017,were reviewed and 35 patients with FURSL and 60 patients with SWL were included.Both groups were compared for retreatment rate,complication rate,SFR,secondary and total number of procedures and operation duration.Results Compared with SWL group,the rate of retreatment(8.6%vs.60.0%,P<0.001),the time of operation[(73.2±29.3)min vs.(92.3±40.8)min,P=0.017]and the number of operations[(1.11±0.32)vs.(2.23±1.14),P<0.001]were significantly decreased in FURSL group,and the SFRS in FURSL group increased significantly in 3 months(66.7%vs.86.7%,P=0.036).The incidence of complications in FURSL group was higher(SWL 5.0%vs.11.4%)but there was no significant difference(P=0.144).Conclusions For treatment of complicated lower pole stones of 1-2 cm,FURSL seems to be a much beter alternatve than SWL with a high SFR and lower retreatment rate.These results support that FURSL can be seen as the valuable alternative for the management of lower pole renal calculi.