输尿管软镜与经皮肾镜处理一期经皮肾镜术后残石的比较

443000 湖北,三峡大学第二人民医院&宜昌市第二人民医院泌尿外科

复杂性,肾结石; 经皮肾镜; 输尿管镜

Comparsion of percutaneous nephrolithotomy and retrograde intrarenal surgery for residual kidney stones after percutaneous nephrolithotomy
Yuan Qiang, Du Dan

Department of Urology, the Second People's Hospital of the Three Gorges University of Medicine, Yichang 443002, China

Complex, kidney stones; Percutaneous nephrolithotomy; Ureterscope

DOI: 10.3877/cma.j.issn.1674-3253.2017.05.006

备注

目的 比较输尿管软镜与经皮肾镜处理复杂性肾结石经皮肾镜碎石取石术(PCNL)术后残石的疗效与安全性。方法 回顾性分析2015 年9 月至2016 年12 月我院一期PCNL 术后残石再次手术的73 例复杂性肾结石患者的临床资料。按再次手术方式不同分为经皮肾镜组(PCNL组,34 例)和输尿管软镜组(RIRS 组,39 例)。比较两组患者再次手术的残石清除率、手术时间、术中出血量、平均住院日、住院费用、留置造瘘管时间及并发症情况。结果 PCNL 组及RIRS 组在年龄、性别、残石总直径、体质量指数、结石位置方面差异无统计学意义。术中出血量为(60±17)ml和(12±6)ml,差异有统计学意义(P<0.01)。手术时间为(35±4)min 和(60±13)min,差异有统计学意义(P<0.01)。住院费用为(17 118±1 719)元和(24 026±1 013)元,差异有统计学意义(P<0.01)。平均住院日为(9.0±1.0)d 和(4.0±0.8)d,差异有统计学意义(P<0.01)。留置肾造瘘管时间为(6.2±0.7)d 和(2.8±0.8)d,差异有统计学意义(P<0.01)。残石清除率为73.6%(25/34)和92.3%(36/39),差异有统计学意义(P=0.031)。PCNL 组发生术后重症感染3 例,术后大出血1 例,使用敏感抗生素及选择性肾动脉栓塞后治愈RIRS 组未出现术后重症感染及大出血。结论 输尿管软镜处理复杂性肾结石PCNL 术后残石较经皮肾镜具有结石清除率高、术中出血少、术后并发症少、留置肾造瘘管时间和平均住院日短等优势,值得在临床应用中大力推广。
Objective To compare the effect and safety of percutaneous nephrolithotomy and retrograde intrarenal surgery in the treatment of complex kidney stones after one stage percutaneous nephrolithotomy. Method The clinical data of 73 patients with residual kidney stone in our hospital from September 2015 to December 2016 were analyzed retrospectively. These patients previously treated with percutaneous nephrolithotomy. These patients were divided into percutaneous nephrolithotomy group and retrograde intrarenal surgery group according to surgical method. Stone clearance rate, operation time, intraoperative hemorrhage, average hospital stay, hospitalization expense and postoperative time of taking nephrostomy tube in the two groups were compared. Result There were no significant differences between the two groups in age, sex, body mass index, residual stone total diameter and residual stone location. The intraoperative hemorrhage was (60±17) ml vs (12±6) ml, the difference was statistically significant (P<0.01). The operation time was (35±4) min vs (60±13) min, the difference was statistically significant (P<0.01). The hospitalization expense was (17 118±1 719) yuan vs (24 026±1 013) yuan, the difference was statistically significant (P<0.01). The average hospital stays was (9.0±1.0) d vs (4.0±0.8) d, the difference was statisticallysignificant (P<0.01). The postoperative time of taking nephrostomy tube was (6.2±0.7) d vs (2.8±0.8) d, the difference was statistically significant (P<0.01). The residual stone clearance rate was 73.6% (25/34) vs 92.3% (36/39), the difference was statistically significant (P=0.031). Three patients occurred severe infection after operation in PCNL group, one patient occurred intraoperative massive hemorrhage who was cured by sensitive antibiotic and selective renal artery embolization. Conclusion RIRS is a better procedure for treating residual calculi after one stage PCNL, it has higher stone clearance rate, less intraoperative hemorrhage, less postoperative complications, shorter average hospital stay and postoperative time of taking nephrostomy. It was worth to promote in clinical.
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