输尿管软镜碎石术与经皮肾镜取石术治疗2~3 cm上尿路结石的效果

Effect of Flexible Ureteroscopy Lithotripsy and Percutaneous Nephrolithotomy in the Treatment of 2-3 cm Upper Urinary Tract Stones

目的:比较输尿管软镜碎石术(flexible ureteroscopy lithotripsy,FURL)与经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗2~3 cm上尿路结石的效果。方法:回顾性分析2018年1月—2022年12月北华大学附属医院收治的95例2~3 cm上尿路结石患者的临床资料。根据手术方式的不同将其分为FURL组(40例)与PCNL组(55例)。PCNL组给予PCNL,FURL组给予FURL。比较两组围手术期指标、结石清除率、血红蛋白下降值、术前及术后1 d肾功能、并发症。结果:FURL组手术时间长于PCNL组,术后住院时间短于PCNL组,血红蛋白下降值低于PCNL组,结石清除率低于PCNL组,差异有统计学意义(P<0.05)。两组术前、术后1 d血肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)水平比较,差异无统计学意义(P>0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。结论:FURL相比于PCNL具有出血量少、康复快的特点,但PCNL结石清除率高,对于2~3 cm上尿路结石的治疗,两种术式均有效。

Objective:To compare the effect of flexible ureteroscopy lithotripsy(FURL)and percutaneous nephrolithotomy(PCNL)in the treatment of 2-3 cm upper urinary tract stones.Method:The clinical data of 95 patients with 2-3 cm upper urinary tract stones admitted to the Affiliated Hospital of Beihua University from January 2018 to December 2022 were retrospectively analyzed.They were divided into FURL group(40 cases)and PCNL group(55 cases)according to different surgical methods.PCNL group was given PCNL,FURL group was given FURL.Perioperative indexes,stone clearance rate,hemoglobin decline value,preoperative and postoperative 1 d renal function and complications were compared between the two groups.Result:The operative time of FURL group was longer than that in PCNL group,the postoperative hospital stay was shorter than that in PCNL group,the hemoglobin decrease value was lower than that in PCNL group,and the stone clearance rate was lower than that in PCNL group,the differences were statistically significant(P<0.05).There were no significant differences in serum creatinine(Scr)and blood urea nitrogen(BUN)levels between the two groups before and 1 day after operation(P>0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion:Compared with PCNL,FURL has the characteristics of less blood loss volume and faster recovery,but PCNL has a high stone clearance rate,and both methods are effective for the treatment of 2-3 cm upper urinary tract stones.