同期与分期经皮肾镜取石术治疗双侧肾输尿管结石的疗效比较

Bilateral simultaneous percutaneous nephrolithotomy versus staged approach for upper urinary system stones

目的:探讨同期与分期经皮肾镜取石术治疗双侧肾输尿管结石的临床疗效。方法:回顾性分析2016年1月—2020年12月肇庆市第一人民医院收治的双侧肾输尿管结石患者233例,其中行双侧同期经皮肾镜取石术128例(BSPCNL组),双侧分期经皮肾镜取石术105例(分期PCNL组),比较两组患者一般资料、结石特征、手术情况及术后疗效。结果:BSPCNL组患者中双肾结石、肾结石+输尿管上段结石及输尿管上段结石分别为22、92、14例,分期PCNL组患者中双肾结石、肾结石+输尿管上段结石及输尿管上段结石分别为23、74.8例,两组结石分布及结石负荷比较差异无统计学意义(P>0.05);两组患者性别、年龄、BMI、术前血红蛋白、术后血红蛋白、术前血肌酐、术后血肌酐等比较差异均无统计学意义(P>0.05)。BSPCNL组总手术时间、出血量、总住院时间及住院费用分别为(99.83±33.61)min、(158.52±78.52)mL、(13.36±4.45)d及(20831.81±6774.00)元,分期PCNL组总手术时间、出血量、总住院时间及住院费用分别为(131.84±47.94)min、(202.98±115.65)mL、(25.41±7.17)d及(30517.95±11976.65)元,两组比较差异有统计学意义(P<0.05)。两组患者结石清除率分别为85.9%和88.6%,并发症发生率分别为14.8%和15.2%,差异均无统计学意义(P>0.05)。结论:对于合适的双侧肾输尿管结石患者,BSPCNL较分期PCNL并不增加并发症及结石残留率,同时可减少患者手术时间、住院时间及住院费用,是安全可行的手术方案。但选择行BSPCNL需要术者具有足够的经验与技术,并在患者自身允许的情况下去完成。

Objective: To analyze the efficacy and safety of bilateral simultaneous and staged percutaneous nephrolithotomy for the treatment of upper urinary system stones. Methods: Clinical data of 233 patients with bilateral upper urinary calculi admitted in First People’s Hospital of Zhaoqing from January 2016 to December 2020 were retrospectively analyzed. One hundred and twenty-eight patients underwent bilateral synchronous percutaneous nephrolithotomy, while 105 patients underwent staged approach. The general conditions, calculi characteristics, surgical conditions and postoperative curative effects of the two groups were compared. Results: In the bilateral simultaneous group, there were 22, 92, and 14 cases of kidney stones, kidney + upper ureteral stones, and upper ureteral stones, respectively. The corresponding distribution of stones in the staging group were 23, 74, and 8 cases. There were no significant differences in stone distribution or stone load between the two groups(P>0.05). There were no significant differences in gender, age, BMI, preoperative hemoglobin, postoperative hemoglobin, preoperative blood creatinine or postoperative blood creatinine between the two groups(P>0.05). The mean total operation time, estimated blood loss, total hospital stay and hospitalization expenses were(99.83±33.61) min,(158.52±78.52) mL,(13.36±4.45) d and(20 831.81±6 774.00) ￥, respectively, in BS group. The corresponding parameters in staging groups were(131.84±47.94) min,(202.98±115.65) mL,(25.41±7.17) d and(30 517.95±11 976.65) ￥, making it significant difference between two groups(P<0.05). The stone clearance rates of the two groups were 85.9% and 88.6%, and the complication rates were 14.8% and 15.2%, respectively, and the differences were not statistically significant(P>0.05). Conclusion: For suitable patients with bilateral renal and ureteral stones, bilateral simultaneous percutaneous nephrolithotomy can reduce the patient’s operation time, hospital stay and hospitalization costs but do not increase complications and stone residues when compared with staging approach, so it is a safe and feasible surgical scheme. However, the surgeon must possess rich experience and skill when perform bilateral simultaneous percutaneous nephrolithotomy, and good condition of patient is also mandatory.