输尿管软镜碎石术与经皮肾镜取石术治疗直径2~4 cm肾结石的临床疗效对比

Clinical efficacy of flexible ureteroscopic lithotripsy vs.percutaneous nephrolithotomy in the treatment of renal calculi with a diameter of 2-4 cm

目的探讨输尿管软镜碎石术(RIRS)与经皮肾镜取石术(PCNL)治疗2~4 cm肾结石的安全性和有效性。方法分析2019年1月至2021年12月广东医科大学附属医院收治的165例2~4 cm肾结石患者临床资料,根据选择的术式分为RIRS组(n=100)和PCNL组(n=65),观察两组患者的临床疗效,组间采用独立样本t检验、秩和检验、χ^(2)检验或Fisher精确率检验。结果所有患者手术均顺利完成。RIRS组与PCNL组清石率比较[87.70%(78/100)和78.00%(57/65)],差异无统计学意义(χ^(2)=2.488,P>0.05);RIRS组与PCNL组手术时间分别为90(65,100)min和50(30,60)min;差异有统计学意义(Z=-7.129,P<0.05);术后血红蛋白(Hb)下降值分别为4.00(-1.00,9.00)g/L和9.00(4.00,6.00)g/L,差异有统计学意义(Z=-3.821,P<0.05);术后住院时间分别为2(2,3)d和4(4,5)d,差异有统计学意义(Z=-8.811,P<0.05)。术后并发症两组比较,RIRS组与PCNL组术后感染率比较[17.00%(17/100)比12.30%(8/65)],差异无统计学意义(χ^(2)=0.675,P>0.05);脓毒血症发生率比较[3.00%(3/100)比0.00%(0/65)],差异无统计学意义(χ^(2)=0.661,P>0.05),术后出血率比较[0.00%(0/100)比6.15%(4/65)],差异有统计学意义(χ^(2)=3.973,P<0.05)。结论治疗2.0~4.0 cm肾结石,RIRS与PCNL均为安全有效的方法,两者清石率相当,与PCNL比较,RIRS具有创伤小、出血更少、恢复快和住院时间短等优势。

Objective To explore the safety and effectiveness of ureteroscopic laser lithotripsy(RIRS)and percutaneous nephrolithotomy(PCNL)for treating 2-4 cm renal stones.Methods A retrospective analysis was conducted on clinical data from 165 patients with 2-4 cm renal stones admitted to Affiliated Hospital of Guangdong Medical University between January 2019 and December 2021.The patients were divided into RIRS group(n=100)and PCNL group(n=65)according to the selected surgery.The clinical efficacy of the two groups was observed.The independent-samples Test,Rank sum test,Chi-Square Test or Fisher’s exact test was used to compare the differences in two groups.Results All patients successfully completed the operation.There was no statistically significant difference in stone clearance rate between RIRS group and PCNL group[78.00%(78/100)vs.87.70%(57/65),χ^(2)=2.488,P>0.05].The operation time was 90(65,100)min and 50(30,60)min in RIRS group and PCNL group,respectively,and the difference was statistically significant(Z=-7.129,P<0.05).The hemoglobin(Hb)level was decreased by 4.00(-1.00,9.00)g/L and 9.00(4.00,6.00)g/L postoperatively in RIRS group and PCNL group,respectively,and the difference was statistically significant(Z=-3.821,P<0.05).The postoperative hospital stay was 2(2,3)d and 4(4,5)d in RIRS group and PCNL group,respectively,and the difference was statistically significant(Z=-8.811,P<0.05).There was no statistically significant difference in postoperative infection rate between RIRS group and PCNL group[17.00%(17/100)vs.12.30%(8/65),χ^(2)=0.675,P>0.05],septicemia rate[3.00%(3/100)vs.0.00%(0/65),χ^(2)=0.661,P>0.05),but the difference in postoperative bleeding rate was statistically significant between two groups[0.00%(0/100)vs.6.15%(4/65),χ^(2)=3.973,P<0.05].Conclusion For the treatment of 2.0-4.0 cm renal stones,both RIRS and PCNL are safe and effective.The stone clearance rate is equivalent.RIRS has the advantages of less trauma,less bleeding,faster recovery and shorter hospital stay than PCNL.