输尿管软镜与经皮肾镜碎石术治疗孤立肾肾结石的对比研究

Comparison of flexible ureteroscopy and percutaneous nephrolithotomy in the treatment of renal stones in patients with a solitary kidney

摘要:

目的：比较输尿管软镜碎石术（flexible ureteroscopy，FURS）和经皮肾镜取石术（percutaneous nephrolithotomy，PCNL）在孤立肾肾结石治疗中的安全性和有效性。方法：回顾性分析我院2010年3月至2016年12月20例孤立肾肾结石的临床资料，其中FURS组8例，PCNL组12例，比较2组结石大小、手术时间、血红蛋白变化、并发症、术后住院时间、肾功能变化和结石清除率。结果：FURS组与PCNL组手术时间分别为（104.4±23.8） min、（125.0±55.4） min，无统计学差异（t=0.988，P=0.336）；术后住院时间分别为（4.3±2.6） d、（6.0±2.8） d，无统计学差异（t=1.429，P=0.170）。FURS组术后第1天血红蛋白下降的中位数为-2.0 g/L（-6.0~8.0 g/L），明显低于PCNL组的6.0 g/L（-3.0~14.0 g/L）（Z=-2.047，P=0.041）。2组并发症均为ClavienⅠ~Ⅱ级，其中FURS组发热1例，全身炎症反应综合征1例，PCNL组发热3例，全身炎症反应综合征1例，输血1例。FURS组术前血肌酐（171.6±113.4） μmol/L，与术后第1天[（163.9±108.9） μmol/L]比较无统计学差异（t=1.025，P=0.345）；PCNL组术前血肌酐（152.4±65.9） μmol/L，与术后第1天[（161.0±56.2） μmol/L]比较无统计学差异（t=-1.114，P=0.289）；2组间术前、术后比较血肌酐差异均无统计学意义（t=-0.470，P=0.644；t=-0.076，P=0.940）。FURS组和PCNL组一期结石清除率分别为62.5%（5/8）、75.0%（9/12），无统计学差异（Fisher检验，P=0.455）。结论：FURS和PCNL均为孤立肾肾结石安全、有效的治疗方法。FURS术中出血少、创伤小，具有微创优势；PCNL结石清除率高，更适合孤立肾铸型结石。

Abstract:

Objective：To compare the safety and efficacy of flexible ureteroscopy and percutaneous nephrolithotomy in the treatment of renal stones in patients with a solitary kidney. Methods：Clinical data of 20 cases of renal stones in a solitary kidney in our hospital between March 2010 and December 2016 were retrospectively analyzed. There were 8 cases of flexible ureteroscopy（FURS） and 12 cases of percutaneous nephrolithotomy（PCNL）. The stone size，operation time，decrease of hemoglobin，incidence of complication，length of postoperative hospitalization，stone-free rate（SFR），change in serum creatinine（Scr） were compared between the two groups. Results：There was no significant difference between the FURS and PCNL groups in operation time[（104.4±23.8） min vs. （125.0±55.4） min，t=0.988，P=0.336] and length of postoperative hospitalization[（4.3±2.6） d vs. （6.0±2.8） d，t=1.429，P=0.170]. The hemoglobin was decreased more significantly in FURS group than in PCNL group[-2.0（-6.0-8.0） g/L vs. 6.0 （-3.0-14.0） g/L，Z= -2.047，P=0.041]. Perioperative complications in two groups were ClavienⅠ to Ⅱgrade，including one case of fever and one case of systemic inflammatory response syndrome in FURS group，and 3 cases of fever，one case of systemic inflammatory response syndrome and one case of blood transfusion in PCNL group. There was no significant difference between the FURS and PCNL groups in postop－erative[（163.9±108.9） μmol/L vs. （161.0±56.2） μmol/L，t=-0.076，P=0.940] and preoperative Scr[（171.6±113.4） μmol/Lvs. （152.4±65.9） μmol/L，t=-0.470，P=0.644]. The SFR of FURS and PCNL group were 62.5%（5/8） and 75.0%（9/12），respectively. Conclusion：FURS has the same safety and efficacy as PCNL in the treatment of renal stones in patients with a solitary kidney. FURS is less traumatic and bleeding. PCNL has a higher SFR especially for staghorn stones in a solitary kidney.