微通道经皮肾镜与输尿管软镜治疗上尿路结石的疗效与安全性比较

Comparison of the efficacy and safety of micro channel percutaneous nephrolithotomy and retrograde intrarenal surgery in the treatment of upper urinary calculi

目的比较分析微通道经皮肾镜取石术(MPCNL)与输尿管软镜碎石术(RIRS)治疗上尿路结石(结石长径为2.0~3.0 cm)的疗效与安全性。方法回顾性研究2018年2月至2021年10月在本院确诊的72例上尿路结石患者的临床资料,将患者随机分为MPCNL组(给予MPCNL治疗)和RIRS组(给予RIRS治疗),每组各36例。记录两组患者的、术后1周、1个月、3个月的结石清除率、血清炎性指标[肿瘤坏死因子(TNF-α)、白细胞介素-10(IL-10)、白细胞介素-6(IL-6)、白细胞介素-4(IL-4)和白细胞介素-2(IL-2)]、视觉模拟评分法(VAS)评分、肾功能指标、手术相关并发症和二期手术情况。结果与MPCNL组比较,RIRS组的术中出血量、手术时间、住院时间、血肌酐、尿素氮降低,而住院费用增加,差异均有统计学意义(均P<0.05)。RIRS组术后1周、术后1个月的结石清除率均较MPCNL组降低(χ^(2)=4.126、5.258,均P<0.05)。术后3 d,RIRS组患者的TNF-α、IL-6、IL-2均较MPCNL组升高,而IL-10、IL-4、VAS评分均较MPCNL组降低(均P<0.05)。两组患者的并发症比较,差异无统计意义(χ^(2)=0.127,P=0.722)。与MPCNL组比,RIRS组患者的二期手术例数较多,差异有统计学意义(χ^(2)=4.235,P=0.040)。结论MPCNL与RIRS均可治疗结石长径为2.0~3.0 cm的上尿路结石患者,两者各有优缺点。MPCNL费用较低,但术中出血量较高,炎症反应较低;RIRS术后出血量较低,但费用和二期手术概率较高,可综合病情及患者意愿个体化制定上尿路结石的治疗方案。

Objective To analyze and compare the efficacy and safety of micro channel percutaneous nephrolithotomy(MPCNL)and retrograde intrarenal surgery(RIRS)in the treatment of 2.0-3.0 cm upper urinary calculi.Methods From February 2018 to October 2021,72 patients with 2.0-3.0 cm upper urinary calculi diagnosed in our hospital were collected retrospectively and divided into two groups:The MPCNL group was given MPCNL,and the RIRS group was given RIRS treatment,with 36 cases in each group.The patient’s hospitalization related indicators,the stone clearance rate and serum inflammatory indicators at 1 week,1 month,and 3 months,serum inflammatory markers after surgery[tumor necrosis factor-α(TNF-α),interleukin-10(IL-10),IL-6,IL-4 and IL-2],visual analogue scale(VAS),renal function(serum creatinine and urea nitrogen),surgery related complications and second-stage surgery were recorded and compared within two groups.Results Compared with the MPCNL group,the intraoperative blood loss,surgery time,hospital stay,creatinine,urea nitrogen in the RIRS group were reduced,and hospitalization expenses were significantly increased(all P<0.05).Compared with the MPCNL group,the stone clearance rate of the RIRS group was lower at 1 week and 1 month after the surgery(χ^(2)=4.126、5.258,all P<0.05).Three days after surgery,compared with the MPCNL group,the TNF-α,IL-6,IL-2 were all increased in the RIRS group,IL-10,IL-4,VAS were all decreased in the RIRS group(all P<0.05).There was no significant difference in complications between two groups(χ^(2)=0.127,P=0.722).Compared with the MPCNL group,the RIRS group had more second-stage surgery(χ^(2)=4.235,P=0.040).Conclusions Both MPCNL and RIRS can be used to treat 2.0-3.0 cm upper urinary calculi.But each has advantages and disadvantages.The cost of MPCNL is lower,but the amount of intraoperative blood loss is higher,and the inflammatory reaction is lower.The postoperative blood loss of RIRS is lower,the inflammatory response is low,but the cost is higher and the probability of second-stage surgery are higher.It is recommended that the treatment plan for upper urinary calculi should be individualized according to the patient's condition and willingness.