RIRS与mPCNL治疗直径≤3cm无积水或轻度肾积水单发肾结石的疗效对比分析

Clinical effect of retrograde intrarenal surgery and microchannel percutaneous nephrolithotripsy in the treatment of single renal stone in diameter≤3 cm without hydronephrosis or with mild hydronephrosis

目的比较输尿管软镜碎石术(RIRS)与微通道经皮肾镜碎石术(mPCNL)治疗直径≤3 cm无积水或轻度肾积水单发肾结石的临床效果。方法回顾性分析2019年1月至2021年6月海南医学院第二附属医院泌尿外科收治的117例直径≤3 cm无积水或轻度肾积水单发结石患者的临床资料,按其手术方式分组,其中RIRS组54例,m PCNL组63例。比较两组患者的手术时间、术后血红蛋白下降值、术后住院时间、结石清除率及术后并发症发生情况。结果m PCNL组患者术后第3天结石清除率为85.71%,明显高于RIRS组的59.25%,差异有统计学意义(P<0.05);m PCNL组患者术后1个月、3个月结石清除率为88.89%和90.47%,RIRS组为85.10%和88.89%,差异均无统计学意义(P>0.05);RIRS组患者术后24 h的血红蛋白下降值为(6.43±3.80)g/L,明显低于m PCNL组的(11.22±5.92)g/L,差异有统计学意义(P<0.05);RIRS组患者的手术时间为(82.15±21.65)min,明显长于m PCNL组的(63.84±18.33)min,术后住院时间为(3.91±0.95)d,明显短于m PCNL组的(8.00±1.36)d,而住院费用为(28747.33±3355.77)元,明显高于m PCNL组的(23431.20±2996.15)元,差异均有统计学意义(P<0.05);m PCNL组患者术后出血率和总并发症发生率分别为14.27%和41.27%,明显高于RIRS组的1.85%和20.37%,差异均有统计学意义(P<0.05)。结论RIRS与m PCNL均是治疗≤3 cm无积水或轻度肾积水肾结石的有效术式;m PCNL术后3 d的清石率、手术时间、住院费用方面优于RIRS,RIRS在处理该类结石上具有创伤更小、住院天数少、术后恢复快等优势。

Objective To compare the clinical effects of retrograde intrarenal surgery(RIRS)and microchannel percutaneous nephrolithotripsy(mPCNL)in the treatment of single renal stone in diameter≤3 cm without hydronephrosis or with mild hydronephrosis.Methods The clinical data of 117 patients with single stone≤3 cm in diameter without hydronephrosis or with mild hydronephrosis admitted to the Department of Urology,the Second Affiliated Hospital of Hainan Medical University from January 2019 to June 2021 were retrospectively analyzed.They were grouped according to their surgical methods,including 54 patients in the RIRS group and 63 patients in the m PCNL group.The operative time,postoperative hemoglobin decline value,postoperative length of hospital stay,stone clearance rate,and postoperative complications were compared between the two groups.Results The stone clearance rate of mPCNL group on the third day after operation was 85.71%,which was significantly higher than 59.25%of RIRS group(P<0.05).The stone clearance rates of patients in the m PCNL group at 1 month and 3 months after operation were 88.89%and 90.47%,and those in the RIRS group were 85.10%and 88.89%,with no statistically significant differences(P>0.05).The decrease value of hemoglobin 24 h after operation in RIRS group was(6.43±3.80)g/L,which was significantly lower than(11.22±5.92)g/L in mPCNL group(P<0.05).The operation time of patients in RIRS group was(82.15±21.65)min,which was significantly higher than(63.84±18.33)min in m PCNL group,and the postoperative length of hospital stay of patients in the RIRS group was(3.91±0.95)d,significantly shorter than(8.00±1.36)d in the mPCNL group,while the hospitalization cost of patients in RIRS group was(28747.33±3355.77)yuan,significantly higher than(23431.20±2996.15)yuan in m PCNL group(P<0.05).The postoperative bleeding rate and total complication rate in m PCNL group were 14.27%,41.27%,respectively,which were significantly higher than 1.85%,20.37%in RIRS group(P<0.05).Conclusion Both RIRS and m PCNL are effective surgical methods in the treatment of kidney stones in diameter≤3 cm without hydronephrosis or with mild hydronephrosis.MPCNL was superior in stone removal rate,operation time,and hospitalization cost 3 days after surgery,while RIRS had advantages of less trauma,shorter length of hospital stay and faster postoperative recovery in the treatment of such stones.