输尿管软镜与经皮肾镜碎石治疗小直径肾结石临床对照研究

Clinical comparison of flexible ureteroscopy and percutaneous nephrolithotripsy in the treatment of small-diameter kidney stones

目的探讨输尿管软镜与mini经皮肾镜碎石治疗小直径肾结石的临床疗效.方法将160例小直径肾结石患者按手术方法分为输尿管软镜组(100例)和经皮肾镜组(60例),输尿管软镜组采用经输尿管软镜碎石治疗,经皮肾镜组采用mini经皮肾镜碎石治疗,术后随访30 d.比较两组的手术时间、术中出血量、住院时间、住院费用、并发症发生率、一次碎石成功率及总结石清除率,于术前术后检测血红蛋白、白细胞、超敏C反应蛋白水平.结果输尿管软镜术组一次碎石成功率及并发症发生率显著低于经皮肾镜术组(P<0.01),术后总结石清除率两组比较差异无统计学意义(P>0.05).与经皮肾镜组相比,输尿管软镜组手术时间较长,术中出血量减少,住院时间缩短,住院费用较高,血红蛋白下降值及超敏C反应蛋白增加值较小,差异均有统计学意义(P<0.01).结论输尿管软镜与mini经皮肾镜碎石治疗小直径肾结石总结石清除效果相当,输尿管软镜虽住院费用较高、手术时间较长,但具有创伤小、住院时间短,且并发症少的优点.

Objective TCompare the clinical efficacy of flexible ureteroscopy and mini-percutaneous nephrolithotomy in the treatment of small-diameter kidney stones.Methods 160 cases of patients with smalldiameter kidney stones were divided into flexible ureteroscopy group(100 cases)and percutaneous nephrolithotomy group(60 cases)according to the surgical method.The flexible ureteroscopy group was treated with flexible ureteroscopy,and the percutaneous nephrolithotomy group was treated with mini-percutaneous nephrolithotomy,and and the two groups were followed up for 30d after operation.Compare the operation time,intraoperative blood loss,length of hospital stay,hospitalization cost,complication rate,success rate of lithotripsy and summary stone clearance rate between the two groups.The levels of hemoglobin,leukocytes,and high-sensitivity C-reactive protein were measured before and after surgery.Results The lithotripsy success rate and complication rate in the flexible ureteroscopy group were significantly lower than those in the percutaneous nephroscope group(P<0.01).There was no significant difference in postoperative stone clearance between the two groups(P>0.05).Compared with the percutaneous nephroscope group,the flexible ureteroscopy group had a longer operation time,reduced intraoperative blood loss,shorter hospital stays,higher hospital costs,smaller Hb decline values and hs-CRP increase values,the differences were statistically significant(P<0.01).Conclusions In the treatment of small-diameter kidney stones,flexible ureteroscopy and mini-percutaneous nephrolithotomy have equivalent total stone clearance effects.Although flexible ureteroscopy has higher hospitalization cost and longer operative time,it has advantages of small trauma,short hospital stay and few complications.