3种术式治疗直径＞2 cm的肾结石疗效对比

Comparison of the efficacy of three surgical procedures for kidney stones with diameter>2 cm

摘要:

目的 比较经皮肾镜、输尿管软镜及智能控压吸引系统联合输尿管软镜治疗>2 cm肾结石的安全性及有效性。方法 收集2019年1月至2022年3月重庆医科大学附属第一医院泌尿外科采用经皮肾镜、输尿管软镜及智能控压吸引系统联合输尿管软镜治疗>2 cm肾结石的90例患者（每组30例），比较3组手术时间、术中出血量、术后住院时间、住院费用、手术并发症发生情况及术后1个月结石清除率。结果 经皮肾镜组手术时间为（54.1±22.7） min，输尿管软镜组为（53.9±27.0） min，短于智能控压吸引系统联合输尿管软镜组的（81.0±28.2） min，有统计学差异（P<0.05）。输尿管软镜组术中出血量为（3.2±2.1） mL，智能控压吸引系统联合输尿管软镜组为（5.7±4.5） mL，少于经皮肾镜组的（16.1±17.2） mL，有统计学差异（P<0.05）。输尿管软镜组术后住院时间为（1.2±0.5） d，智能控压吸引系统联合输尿管软镜组为（1.5±1.7） d，短于经皮肾镜组的（6.4±5.2） d，有统计学差异（P<0.05）。智能控压吸引系统联合输尿管软镜组住院费用为（2.3±0.4）万元，少于输尿管软镜组的（2.7±0.4）万元，有统计学差异（P<0.05）；经皮肾镜组为（2.6±0.7）万元，与其余2组无统计学差异（P>0.05）。输尿管软镜组发热发生率为33.3％，高于经皮肾镜组的10.0％，智能控压吸引系统联合输尿管软镜组为3.3％，有统计学差异（P<0.05）。经皮肾镜组肾盏撕裂出血发生率为3.3％，输尿管软镜组为0.0％，智能控压吸引系统联合输尿管软镜组为0.0％，无统计学差异（P>0.05）。智能控压吸引系统联合输尿管软镜组肾盂肾盏黏膜损伤发生率为3.3％，低于经皮肾镜组的26.7％和输尿管软镜组的40.0％，有统计学差异（P<0.05）。经皮肾镜组肾周血肿发生率为3.3％，输尿管软镜组为0.0％，智能控压吸引系统联合输尿管软镜组为0.0％，无统计学差异（P>0.05）。经皮肾镜组术后1个月结石清除率为73.3％，输尿管软镜组为20.0％，智能控压吸引系统联合输尿管软镜组为46.7％，3组间差异有统计学意义（P<0.05）。结论 经皮肾镜、输尿管软镜及智能控压吸引系统联合输尿管软镜治疗>2 cm肾结石都是可选择的，经皮肾镜在清石率方面最有优势，但并发症发生率高且较严重。智能控压吸引系统联合输尿管软镜清石率高于输尿管软镜且并发症发生率更低，智能控压吸引系统安全高效值得推广应用，3种术式应根据具体情况选择。

Abstract:

Objective To compare the safety and efficacy of percutaneous nephrolithotomy，flexible ureteroscope，and intelligent pressure-controlled suction system combined with flexible ureteroscope in the treatment of kidney stones with diameter>2 cm.Methods The clinical data of 90 patients（30 cases per group） with kidney stones with diameter>2 cm treated by percutaneous nephrolithotomy， flexible ureteroscope，and intelligent pressure-controlled suction system combined with flexible ureteroscope from January 2019 to March 2022 in Department of Urology，The First Affiliated Hospital of Chongqing Medical University were collected. The operation time，the intraoperative bleeding volume，the postoperative hospitalization time，the hospitalization cost，the incidence of surgical complications，and the stone clearance rate in 1 month after operation were compared among the three groups.Results The operation time in the percutaneous nephrolithotomy group[（54.1±22.7） min] and the flexible ureteroscope group[（53.9±27.0） min] was shorter than that in the intelligent pressure-controlled suction system combined with flexible ureteroscope group[（81.0±28.2） min] with statistical differences（P<0.05）. The intraoperative bleeding volume in the flexible ureteroscope group[（3.2±2.1） mL] and the intelligent pressure-controlled suction system combined with flexible ureteroscope group[（5.7±4.5） mL] was less than that in the percutaneous nephrolithotomy[（16.1±17.2） mL] with statistical differences（P<0.05）. The postoperative hospitalization time in the flexible ureteroscope group[（1.2±0.5） d] and the intelligent pressure-controlled suction system combined with flexible ureteroscope group[（1.5±1.7） d] was shorter than that in the percutaneous nephrolithotomy group[（6.4±5.2） d] with statistical differences（P<0.05）. The hospitalization cost in the intelligent pressure-controlled suction system combined with flexible ureteroscope group[（2.3±0.4） ten-thousand yuan] was less than that in the flexible ureteroscope group[（2.7±0.4） ten-thousand yuan yuan] with statistical differences（P<0.05）. While there were no statistically differences between the percutaneous nephrolithotomy group[（2.6±0.7） ten-thousand yuan yuan] and the other two groups in terms of the hospitalization cost（P>0.05）. The incidence of fever in the flexible ureteroscope group （33.3%） was higher than that in the percutaneous nephrolithotomy group（10.0%） and the intelligent pressure-controlled suction system combined with flexible ureteroscope group（3.3%） with statistical differences（P<0.05）. The incidence of renal calyx tear bleeding was 3.3%，0.0% in the flexible ureteroscope group，and 0.0% in the intelligent pressure-controlled suction system combined with flexible ureteroscope group，respectively，without statistical differences（P>0.05）. The incidence of renal pelvis and renal calyx mucosal injury in the intelligent pressure-controlled suction system combined with flexible ureteroscope group（3.3%） was lower than that in the percutaneous nephrolithotomy group（26.7%） and the flexible ureteroscope group（40.0%） with statistical differences（P<0.05）. The incidence of perirenal hematoma was 3.3%，0.0% in the flexible ureteroscope group，and 0.0% in the intelligent pressure-controlled suction system combined with flexible ureteroscope group，respectively，without statistical differences（P>0.05）. The stone clearance rate in 1 month after operation was 73.3%，20.0% in the flexible ureteroscope group，and 46.7% in the intelligent pressure-controlled suction system combined with flexible ureteroscope group，respectively，with statistical differences（P<0.05）.Conclusion Percutaneous nephrolithotomy，flexible ureteroscope， and intelligent pressure-controlled suction system combined with flexible ureteroscope are optional in the treatment of kidney stones with diameter>2 cm. Percutaneous nephrolithotomy has the most advantageous in the stone clearance rate，but the incidence of surgical complications is high and the complications are more severe. Intelligent pressure-controlled suction system combined with flexible ureteroscope has higher stone clearance rate than the flexible ureteroscope and lower complications rate. The intelligent pressure-controlled suction system combined with flexible ureteroscope is safe and efficient，so it’s worth promoting the application. The three surgical procedures should be selected according to the actual situations.