输尿管软镜碎石术与经皮肾镜碎石术治疗2~3 cm肾结石的疗效分析

Comparison of flexible ureteroscopy lithotripsy andpercutaneous nephrolithotomy in the treatment of 2-3 cm renal calculi

目的比较输尿管软镜碎石术(flexible ureteroscopy lithotripsy,FURL)与经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)治疗2~3 cm肾结石的临床疗效。方法回顾分析2017年7月—2020年5月徐州医科大学附属医院收治的298例结石直径2~3 cm的肾结石患者,将FURL治疗的146例患者纳入观察组,将PCNL治疗的152例患者纳入对照组,测定入组患者的结石直径、位置、数量,体重指数,血红蛋白(hemoglobin),白细胞计数,肌酐值,手术时间,术后并发症,术后住院时间,总费用,结石清除率。结果观察组术后24 h血红蛋白下降值、术后住院时间、并发症发生率低于对照组(P<0.05);观察组手术时间、术后24 h血红蛋白值高于对照组(P<0.05);观察组位于肾下盏结石清除率低于对照组(P<0.05)。结论FURL和PCNL治疗2~3 cm肾上、中盏结石均具有较好疗效,但FURL术中出血及术后并发症少,更符合加速康复外科理念,值得临床推广应用。

Objective To compare the clinical effectiveness of flexible ureteroscopy lithotripsy(FURL)and percutaneous nephrolithotomy(PCNL)in the treatment of 2-3 cm renal calculi.Methods A total of 298 renal calculus patients(with a diameter of 2-3 cm)in the Affiliated Hospital of Xuzhou Medical University from July 2017 to May 2020 were enrolled and their clinical data was retrospectively analyzed.Then,146 patients receiving FURL were set as an observation group and 152 patients treated with PCNL were set as a control group.The stone size and location,the number of stones,body mass index(BMI),counts of hemoglobin(Hb)and white blood cells(WBC)and creatinine(Cr)value were determined.The duration of operation,postoperative complications,postoperative length of hospitalization stay,total expense and stone clearance rate were recorded.Results The decrease of hemoglobin counts 24 h after operation,postoperative length of hospitalization stay and the incidence of complications were lower in the observation group than in the control group(P<0.05).The duration of operation and hemoglobin counts 24 h after operation were higher in the observation group than in the control group(P<0.05).The stone clearance rate in the lower calyx was lower in the observation group than in the control group(P<0.05).Conclusions Both FURL and PCNL are effective in the treatment of 2-3 cm calculi in the upper and middle calyx.FURL presents less blood loss and postoperative complications,which is more consistent with the conception of enhanced recovery after surgery and worthy of application.