一次性输尿管软镜应用可弯曲负压外鞘治疗2~3 cm肾结石的临床观察

Clinical observation of disposable flexible ureteroscopy in the treatment of 2-3cm renal calculi with flexible negative pressure external sheath

目的:观察一次性输尿管软镜应用可弯曲负压外鞘治疗2~3 cm肾结石的有效性及安全性。方法:回顾性分析2022年3月—2023年5月郑州大学第二附属医院收治的70例2~3 cm肾结石患者的临床资料,其中输尿管软镜(retrograde intrarenal surgery, RIRS)组38例,超微通道经皮肾镜(super-mini percutaneous nephrolithotomy, SMP)组32例。2组患者结石直径、结石位置、结石CT值、积水程度等差异无统计学意义(P>0.05)。观察2组手术时间、术后并发症、血红蛋白下降值、术后1 d及术后2周清石率。结果:SMP组手术时间为(52.25±6.27) min,短于RIRS组的(65.76±9.27) min;但血红蛋白下降值为(8.56±3.85) g/L,大于RIRS组的(5.73±3.25) g/L;RIRS组术后1 d清石率为65.8%,低于SMP组的87.5%,但2组术后2周清石率(86.8%vs 93.8%)差异无统计学意义。结论:对于2~3 cm肾结石,RIRS应用负压吸引外鞘安全、有效,远期能够保持与SMP相似的清石率,且更加微创。

Objective:To evaluate the efficacy and safety of flexible external sheath for the treatment of 2-3cm renal calculi.Methods:The clinical data of 70cases of 2-3cm renal calculi in Second Affiliated Hospital of Zhengzhou University from March 2022to May 2023were retrospectively analyzed,including 38cases in the retrograde intrarenal surgery(RIRS)group and 32cases in the super-mini percutaneous nephrolithotomy(SMP)group.There were no significant differences in stone diameter,stone location,CT value or degree of hydronephrosis between the two groups(P>0.05).The operation time,postoperative complications,hemoglobin decline and stone removal rate on the first day and 2weeks after operation were observed.Results:The operation time of SMP group was(52.25±6.27)min,which was better than that of RIRS group([65.76±9.27]min),but the decrease of hemoglobin([8.56±3.85]g/L)was greater than that of RIRS group([5.73±3.25]g/L).The 1-day stone removal rate(65.8%)in the RIRS group was lower than that in the SMP group(87.5%),but the 2-week stone removal rate(86.8%vs 93.8%)showed no significant difference between the two groups.Conclusion:The application of RIRS using negative pressure extractive sheath for 2-3cm renal calculi is safe,effective,and more minimally invasive,and can maintain a stone removal rate similar to SMP in the long term.