输尿管软镜钬激光碎石术与微创经皮肾镜碎石术治疗2~3cm肾结石的疗效比较

Comparison of the Curative Effect between FURSL and MPCNL on 2-3cm of Kidney Stones

目的:比较输尿管软镜钬激光碎石术(FURSL)与微创经皮肾镜碎石术(MPCNL)治疗2~3cm肾结石的疗效及安全性。方法:将2018年1月至2019年1月东莞市人民医院泌尿外科收治的2~3cm肾结石患者160例随机分组,分为FURSL组(n=80)和MPCNL组(n=80),比较两组术前、术中与术后各指标如:肾功能、感染性指标的变化、疼痛视觉模拟评分(VAS)及并发症发生率。结果:两组病例术前基本资料无统计学差异;FURSL组术中出血量、住院时间、住院费用、血红蛋白下降值、一期结石清除率低/短于MPCNL组(P<0.05),手术时间较MPCNL组长(P<0.05);两组二期结石清除率比较差异无统计学意义(P>0.05);两组术后2d BUN、Scr、PCT明显升高(P<0.05),且FURSL组术后2d BUN、PCT及其治疗前后差值低于MPCNL组(P<0.05),而两组Scr比较差异无统计学意义(P>0.05);FURSL组术后1d、术后2d VAS评分低于MPCNL组(P<0.05);FURSL组术后3个月内并发症发生率低于MPCNL组(P<0.05)。结论:FURSL术与MPCNL术治疗2~3cm肾结石均安全有效,但FURSL手术为经自然腔道技术,无手术伤口,具有创伤小、术后恢复快、对肾功能损伤小、疼痛轻、并发症风险低等优势。但对于2~3cm肾结石,FURSL手术时间较MPCNL术有所延长,并且其一期手术结石清除率也较MPCNL术低,应依据患者情况选择手术方式。

Objective:To compare the curative effect and safety between flexible ureteroscopic lithotripsy(FURSL)and mini-percutaneous nephrolithotomy(MPCNL)in the treatment of 2-3 cm of kidney stones.Methods:A total of 160 patients with 2-3cm of kidney stones who were admitted to Urology Department of Dongguan People's Hospital between January 2018 and January 2019 were randomly divided into FURSL group(n=80)and MPCNL group(n=80).The preoperative,intraoperative and postoperative indexes such as changes in renal function and infectious indexes,pain visual analogue score(VAS),and incidence of complications were compared between the two groups.Results:There were no statistical differences in preoperative basic data between the two groups.The intraoperative blood loss,hospitalization time,hospitalization costs,decreased value of hemoglobin and one-stage stone clearance rate of FURSL group were less/shorter/lower than those of MPCNL group(P<0.05),while the operation time was longer than MPCNL group(P<0.05).There was no significant difference in one-stage stone clearance rate between the two groups(P>0.05).BUN,Scr and PCT in both groups were significantly increased at 2 days after operation(P<0.05).Besides,BUN,PCT and their differences before and after treatment in FURSL group at 2 days after operation were lower than those in MPCNL group.However,there was no significant difference in Scr between the two groups(P>0.05).VAS scores of FURSL group were lower than those of MPCNL group at 1 day and 2 days after operation(P<0.05).The incidence of complications in FURSL group was lower than that in MPCNL group within 3 months after operation(P<0.05).Conclusion:Both fursl and MPCNL are safe and effective in the treatment of 2-3 cm renal calculi.However,fursl is a natural lumen technique with no surgical wound.It has the advantages of small trauma,quick recovery,small damage to renal function,light pain and low risk of complications.However,for 2-3 cm renal calculi,the operation time of fursl is longer than that of MPCNL,and the stone clearance rate of fursl is lower than that of MPCNL,so the operation method should be selected according to the patient's condition.