微通道经皮肾镜取石术和逆行肾内手术治疗老年输尿管上段直径>1 cm结石的疗效及对生活质量的影响

The efficacy and impact on quality of life in the elderly patients with proximal ureteral stones larger than 1 cm who reciveing minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery

目的比较微通道经皮肾镜取石术(MPCNL)和逆行肾内手术(RIRS)治疗直径大于1.0cm老年单侧输尿管上段结石的疗效以及对患者生活质量的影响。方法前瞻性收集山西医科大学第一医院2021年1月到2022年12月共104例患者。依据纳入及排除标准,最终纳入88例患者,MPCNL组32例,RIRS组56例,采用独立样本t检验、χ^(2)检验或Fisher确切概率法比较两组患者一般资料、结石特征、术中术后指标的差异,并应用SF-36健康调查量表进行生活质量评分。结果两组患者年龄[(67.52±7.41)岁比(67.38±7.25)岁]、性别[男/女:19/13例比36/20例]、体质指数[(23.74±2.93)kg/m^(2)比(23.70±2.57)kg/m^(2)]、结石位置(左/右:20/12例比38/18例)、结石CT值[(1035.7±275.7)HU比(973.3±253.8)HU]、肾积水程度(轻/中/重:9/20/3例比16/38/2例)以及结石最大径[(14.12±3.69)mm比(13.34±2.99)mm]、术后并发症发生率[15.6%(5/32)比14.3%(8/56)]差异均无统计学意义(P>0.05)。两组结石清除率[96.9%(31/32)比80.4%(45/56)]、手术时间[(44.44±9.91)min比(54.69±11.94)min]、住院时间[(5.27±2.27)d比(8.00±2.19)d]差异有统计学意义(P<0.05)。术前两组患者8个维度各项评分差异无统计学意义(P<0.05)。出院当天SF-36评分,MPCNL组较RIRS组在生理功能、生理职能、躯体疼痛、社会功能、情感职能、精神健康等维度得分较低,差异有统计学意义(P<0.05),但总体健康、活力等维度评分无统计学意义(P>0.05)。术后1个月SF-36评分,MPCNL组较RIRS组在躯体疼痛、社会功能等维度得分较低,差异有统计学意义(P<0.05),其余维度评分无统计学意义(P>0.05)。结论对于直径大于1.0cm老年单侧输尿管上段结石患者,MPCNL组较RIRS组手术时间短、结石清除率高,但住院时间较长,并且对患者生活质量影响相对较大。

Objective To compare the efficacy and impact on the quality of life of elderly patients of minimally invasive percutaneous nephrolithotomy(MPCNL)and retrograde intrarenal surgery(RIRS)in the treatment of unilateral upper ureteral calculi larger than 1.O cm in diameter.Methods A total of 104 patients were prospectively collected from January 2021 to December 2022 in the First Hospital of Shanxi Medical University.Based on the inclusion and exclusion criteria,88 patients were finally included,32 patients in the MPCNL group and 56 patients in the RIRS group,and the independent samples t-test,χ^(2)test,or Fisher's exact probability method were used to compare the differences in the general information,stone characteristics,and intraoperative and postoperative indexes between the two groups,and the quality-of-life scores were applied with the SF-36 Health Survey form.Results There were no significant differences in age[(67.52±7.41)years and(67.38±7.25)years],gender[ale/female:19/13 cases and 36/20 cases],body mass index[(23.74±2.93)kg/m^(2)and(23.70±2.57)],stone location(left/right:20/12 cases and 38/18 cases),degree of hydronephrosis(mild/moderate/severe:9/20/3 cases and 16/38/2 cases),stone maximum diameter[(14.12±3.69)mm and(13.34±2.99)mm],stone CT values[(1035.7±275.7)HU and(973.3±253.8)HU]and postoperative complications[15.6%(5/32)and 14.3%(8/56)]etween the two groups of patients(P>0.05).However,there were significant difference in stone clearance rate[96.9%(31/32)us.80.4%(45/56)],and the operation time[(44.44±9.91)min vs.(54.69±11.94)min]etween the two groups.The hospital stay in the RIRS group was shorter than that in the MPCNL group[(5.27±2.27)d us.(8.00±2.19)d,P<0.05].There was no significant difference in the scores of eight dimensions between the two groups before surgery(P<0.05).At the day of discharge,patients in the MPCNL group had significantly lower mean scores than the RIRS group on six different subscales of the SF-36 questionnaire,namely,physical functioning,role-physical,bodily pain,social functioning,role-emotional and mental health.No differences in the mean scores for general health and vitality between the two groups were noted.In terms of SF-36 scores at one month after operation,the MPCNL group had lower scores in physical pain and social function than the RIRS group and the difference was statistically significant(P<o.05).No differences in the mean scores for other domains at one month after operation between patients undergoing MPCNL and those undergoing RIRS were noted.Conclusions For patients with unilateral upper ureteral calculi larger than 1O cm in diameter,MPCNL has higher stone-free rate and shorter operation time than RIRS,but longer hospitalization time,and MPCNL has a greater impact on the quality of life of patients with ureteral calculi than RIRS in many aspects.