可视穿刺辅助经皮肾镜与输尿管软镜治疗肾盏憩室结石的比较

Visual needle percutaneous nephroscopy versus flexible ureteroscopy in the treatment of calyceal diverticular calculi

目的比较可视穿刺辅助经皮肾镜碎石取石术(PCNL)与输尿管软镜钬激光碎石治疗治疗肾盏憩室结石的有效性及安全性。方法回顾性分析2018年4月至2020年7月收治的9例行可视穿刺辅助PCNL(可视穿刺组)及9例行输尿管软镜(输尿管软镜组)手术共18例(男7例,女11例)肾盏憩室结石患者的临床资料。首先提取两组患者的年龄、性别、BMI、结石直径、肾盏憩室结石位置、术前尿路感染情况等;手术完成后,比较两组患者的手术时间、术后住院时间、视觉模拟量表(VAS)评分、结石清除率、术后症状缓解率和并发症发生率等。结果两组的基线数据比较,差异无统计学意义(P均>0.05)。18例患者顺利完成手术。可视穿刺组中2例先由输尿管软镜检查未发现憩室口,后转入该组经可视穿刺手术顺利完成碎石取石;输尿管软镜组1例因术中憩室内出血,一期未完全碎石,二期完成碎石。两组在平均手术时间、术后症状缓解率、术后结石残留率、术后并发症发生率方面差异无统计学意义(P均>0.05)。输尿管软镜组术后住院时间[(2.33±1.00)d vs(5.44±1.01)d,P<0.01]和VAS评分[(2.00±1.00)分vs(3.56±1.13)分,P<0.01]优于可视穿刺组。结论对于肾盏憩室结石,软镜可作为首选治疗方案;若软镜无法探寻肾盏憩室,可转为可视穿刺手术,可视穿刺术亦是一种安全有效的治疗方式。

Objective To compare the efficacy and safety of visual needle percutaneous nephrolithotomy(V-PCNL) and flexible ureteroscopy(F-URS) in the treatment of calyceal diverticular calculi.Methods A retrospective analysis was performed on the clinical data of 18 patients(7 males and 11 females) who underwent V-PCNL(V-PCNL group, n=9) and F-URS(F-URS group, n=9) from April 2018 to July 2020.The data on patient age, gender, BMI,stone size, diverticulum location and preoperative urinary tract infection were collected.The operative time, postoperative hospital stay, visual analogue scale(VAS) score, stone clearance rate, postoperative symptom relief rate and complication rate were compared between two groups.Results There were no statistical differences of baseline data between two groups(all P>0.05).The operations were successfully completed in 18 patients.After no diverticulum orifice was found in 2 cases by flexible ureteroscopy, they were transferred to V-PCNL group to complete the lithotripsy successfully.In F-URS group, lithotripsy was completed in the second-stage in 1 case because of intraoperative diverticulum bleeding during the first-stage surgery.There were no significant differences in average operation time, postoperative symptom remission rate, postoperative residual calculus rate and postoperative complications rate between two groups(all P>0.05).However, VAS score[(2.00±1.00)vs(3.56±1.13),P<0.01] and postoperative hospital stay[(2.33±1.00)d vs(5.44±1.01)d, P<0.01]in F-URS group were superior to those in V-PCNL group.Conclusion In the treatment of calyceal diverticular calculi, F-URS can be considered as the first choice, and V-PCNL can be a safe alternative method if F-URS fail to explore calyceal diverticulum.