超微经皮肾镜取石术与微创经皮肾镜取石术治疗上尿路结石的对比研究

Comparative studies between super-mini percutaneous nephrolithotomy and minimally invasive percutaneous nephrolithotomy for upper urinary stones

目的:比较超微经皮肾镜取石术(SMP)与微创经皮肾镜取石术(MPCNL)治疗上尿路结石的疗效,评价SMP治疗上尿路结石的价值。方法:收集49例SMP(SMP组)和同期49例MPCNL(MPCNL组)治疗上尿路结石患者的临床资料,比较两组手术时间、术后血红蛋白下降量、术后1 d即时无石率、术后24 h视觉模拟疼痛评分(VAPS)、并发症发生率、住院时间及术后3个月无石率。结果:SMP组中44例成功施行SMP,5例因术中出血致视野不清改MPCNL(18F peer-away鞘)成功完成手术。MPCNL组中48例成功完成手术,1例因穿刺失败,终止手术,二期行软性输尿管镜碎石取石术(RIRS)。SMP组较MPCNL组平均血红蛋白下降量低(8.3 g/L vs.9.8 g/L,P=0.014)、全身炎症反应综合征(SIRS)发生率低(2.3%vs.4.2%,P=0.046)、无管化率高(93.2%vs.37.5%,P=0.012)、住院时间短(3.5 d vs.4.5 d,P=0.035),但平均手术时间较长(70.5 min vs.58.6 min,P=0.023);术后并发症发生率(13.6%vs.18.8%,P=0.158)、术后平均24 h VAPS评分(3.6分vs.4.1分,P=0.290),术后1 d即时无石率(90.9%vs.89.6%,P=0.131)、3个月后无石率(95.5%vs.97.9%,P=0.084)比较差异无统计学意义。结论:SMP术中出血少、肾盂内压力低,术后并发症发生率低、恢复快、住院时间短,为上尿路结石的治疗提供了一个新的选择。

Objective:To compare the difference between super-mini percutaneous nephrolithotomy(SMP)and minimally invasive percutaneous nephrolithotomy(MPCNL)for upper urinary stones,and to evaluate the value of SMP in the treatment of upper urinary calculi.Method:The data of 49 patients with upper urinary stones treated by SMP(SMP group)and the data of 49 patients with upper urinary stones treated by MPCNL(MPCNL group)during the same period were collected.The operative time,postoperative one-day instant stone free rate,postoperative hemoglobin,postoperative 24 h visual analog pain score(VAPS),the incidence of complications,hospital stay and postoperative 3-month stone free rate were compared.Result:In the SMP group,44 cases were successfully completed,but 5 cases were converted to MPCNL(18 F peer-away sheath)due to intraoperative hemorrhage.In MPCNL group,48 cases were successfully completed,but 1 case failed due to the failure of puncture,who was treated by flexible ureteroscopic lithotripsy later.Compared with MPCNL group,the mean decreased hemoglobin level of SMP group was lower(8.3 g/L vs.9.8 g/L,P=0.014),the incidence of SIRS of SMP group was lower(2.3%vs.4.2%,P=0.046),the rate of tubless SMP was higher(93.2%vs.37.5%,P=0.012),and hospital stay of SMP group was shorter(3.5 d vs.4.5 d,P=0.035).But the mean operative time of SMP group was longer(70.5 min vs.58.6 min,P=0.023).There was no significant difference in the postoperative complication rate(13.6%vs.18.8%,P=0.158),the postoperative 24-hour VAPS(3.6 vs.4.1,P=0.290),instant stone free rate(90.9%vs.89.6%,P=0.131)or postoperative 3-month stone free rate(95.5%vs.97.9%,P=0.084).Conclusion:SMP provide a new option for the treatment of upper urinary calculus because of its less blood loss,lower pressure in the renal pelvis,lower incidence of postoperative complications,faster recovery and shorter hospital stay.