内镜下肾内联合手术与多通道经皮肾镜术治疗复杂肾结石的前瞻性随机对照研究

A Comparison Between Endoscopic Combined Intra-Renal Surgery and Minimally Invasive Percutaneous Nephrolithotomy for Complex Renal Calculi:A Prospective Randomized Controlled Trial

目的比较内镜下肾内联合手术(endoscopic combined intra-renal surgery,ECIRS)与多通道经皮肾镜碎石术(multi-tract percutaneous nephrolithotomy,MPCNL)治疗复杂性肾结石的有效性和安全性。方法选取我院2018年10月~2019年9月收治的复杂性肾结石患者300例行前瞻性随机对照研究,随机分为ECIRS和MPCNL组,每组150例。比较两组患者手术时间、术后住院时间、术后血红蛋白下降程度、C反应蛋白升高值、并发症发生率及术后一期净石率。结果ECIRS组与MPCNL的手术时间分别为(124.31±22.61)min VS(121.45±25.52)min,两组比较无统计学差异(P=0.30)。但与MPCNL组相比,ECIRS组的碎石清除率较高[88.7%(133/150)VS 80%(120/150)],术后住院时间较短[(4.29±1.22)d VS(7.46±1.28)d],术后血红蛋白下降值较低[(10.84±2.53)g/L VS(18.43±6.55)g/L],C反应蛋白升高值较小[(11.74±1.14)mg/L VS(14.42±3.09)mg/L],经皮肾通道数量较少,并发症发生率较低[27.3%(41/150)VS 62%(93/150)],差异具有显著性(P<0.05)。结论ECIRS在斜仰卧截石位取石治疗复杂性肾结石,结合了PCNL和输尿管软镜碎石术(flexible ureteroscopy lithotripsy,FURL)的优势,能有效减少经皮肾通道的数目,减少出血量,降低潜在并发症发生率,并能保持较高的结石清除率,具有良好的有效性和安全性,因此值得临床应用。

Objective To evaluate the technical effectiveness as well as surgical safety in endoscopic combined intra-renal surgery(ECIRS)and multi-tract percutaneous nephrolithotomy(MPCNL)for the complex calculi patients.Methods A prospective randomized controlled trail was performed in 300 patients initially diagnosed complex calculi from October 2018 to September 2019.These patients were randomly divided into ECIRS Group and MPCNL Group based on the random number table.Factors including operating time,total length of hospital stay after the procedure,decrease of hemoglobin level,increase of CRP level,complete stone free rate and postoperative complication rate between the two groups were documented and analyzed respectively.Results There was no statistical significance between ECIRS group and MPCNL group in operating time,which was(124.31±22.61)min VS(121.45±25.52)min(P=0.30).But the stone clearance rate of ECIRS group was 88.7%,which was significantly higher than 80%of MPCNL group(P<0.05).There were statistical significant differences between ECIRS group and MPCNL group in hospitalization time[(4.29±1.22)d VS(7.46±1.28)d],the hemoglobin changes[(10.84±2.53)g/L VS(18.43±6.55)g/L],C-reaction protein changes[(11.74±1.14)mg/L VS(14.42±3.09)mg/L],the number of percutaneous renal channels(150 VS 330),and the operative complication rate[27.3%(41/150)VS 62%(93/150)],P<0.05.Conclusion Combined with the advantages of PCNL and FURL,ECIRS can effectively reduce the number of percutaneous renal channels,the blood loss and the incidence of potential complications,and can maintain a high calculus clearance rate.It is worthy of clinical application for its good efficacy and safety.