两种不同肾镜下激光碎石取石术治疗上尿路结石的疗效

Efficacy and Prognosis:Retrograde Intrarenal Surgery vs.Minimally Invasive Percutaneous Nephrolithotomy for Upper Urinary Tract Calculi

目的 探索微通道经皮肾镜碎石取石术(mini-percutaneous nephrolithotomy,mPCNL)和电子输尿管软镜钬激光碎石术(retrograde Intra-Renal Surgery,RIRS)治疗上尿路结石的疗效和预后。方法 选择2021年1月至2022年6月,上尿路结石患者69例,根据手术方式分为观察组和对照组,观察组患者47例采用RIRS治疗,对照组患者22例采用mPCNL治疗。记录两组患者手术时间、出血量、住院费用。术后3个月比较两组患者结石清除率和术后并发症发生率,术后3个月检测患者尿酸(uric Acid,UA)、肌酐(creatinine,Cr)、β2微球蛋白(beta-2 microglobulin,β2-MG)水平。再根据碎石清除率分为结石残留组和结石清除组,确定分组后,采用Logistic回归分析比较两组患者的基本资料包括性别、年龄、病程、BMI、结石位置、结石侧别、术前血尿、疼痛、结石长径、CT值、手术方式等对结石清除的影响。结果 观察组手术时间短于对照组(P<0.001),出血量、住院费用少于对照组(P<0.001)。术后3个月观察组结石清除率91.49%高于对照组,术后3个月观察组UA(90.6±3.8)μmol/L、β2-MG水平(4.13±0.2) mg/L低于对照组(P<0.05)。经二元Logistic回归分析,BMI≥25 kg/m2、CT值≥1 000 HU、结石长径>5 mm、PCNL手术是影响患者结石清除独立因素。结论 对上尿路结石患者实施电子输尿管软镜钬激光碎石术效果更好,可提高结石清除率。但预后也可受到多种因素影响,对此需综合考虑,合理选择术式。

Objective To explore and compare the efficacy and prognosis of mini-percutaneous nephrolithotomy(mPCNL)and retrograde intrarenal surgery(RIRS)in the treatment of upper urinary calculi.Methods Totally 69 patients with upper urinary tract stones treated over the period from Jan.2021 to Jun.2022 were divided into an observation group(including 47 patients given RIRS)and a control group(including 22 patients given mPCNL)by surgical methods.Their operation time,bleeding volume and hospitalization costs were recorded.The stone clearance rate and postoperative complication rate were compared between the two groups 3 months after the surgery,and the uric acid(UA),creatinine(Cr)andβ_(2) microglobulin(β_(2)-MG)levels were measured 3 months after the surgery.The patients were then divided into a stone residual group and stone removal group by the rate of gravel removal.After that,logistic regression analysis was used to compare the basic data between two groups,including gender,age,disease duration,BMI,stone location,stone side,preoperative hematuria,pain,stone length,CT value,surgical methods and other effects on stone removal.Results The operation time was shorter in the observation group than in the control group(P<0.001),and the bleeding volume and hospitalization cost were less in the observation group(P<0.001).The stone clearance rate of the observation group was 91.5%,higher than that of the control group,and the UA level[(90.6±3.8)μmol/L]andβ_(2)-MG level[(4.13±0.2)mg/L]of the observation group after the surgery were lower than those of the control group(P<0.05).It was founded via the binary Logistic regression analysis that BMI≥25 kg/m^(2),CT value≥1000 HU,stone long diameter>5 mm and PCNL surgery were independent factors affecting the stone clearance of the patients.Conclusions Compared with mPCNL,RIRS features better curative effect and higher stone clearance rate in treating patients with upper urinary tract calculi.However,the prognosis is also affected by a variety of factors,which should be considered comprehensively for a reasonable selection of surgical methods.