Comparison of clinical efficacy between percutaneous nephrolithotripsy and transurethral flexible ureteroscopic lithotripsy in the treatment of renal calculi
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摘要:
目的 对比经皮肾镜碎石取石术(percutaneous nephrostolithotomy，PCNL)和经尿道输尿管软镜碎石取石术(flexible ureteroscopic lithotripsy，FURL)的临床效果。 方法 选取四川大学华西医院泌尿外科2019年2月—2020年2月收治的肾结石患者150例为研究对象，根据手术方式分为PCNL组(64例)和FURL组(86例)。观察和比较2组患者手术时间、术中出血量、住院时间和结石清除率，并统计和比较2组患者术后并发症发生情况。 结果 对于直径 < 2 cm的结石，2组手术时间和术后结石清除率比较差异无统计学意义(均P>0.05)，而PCNL组术中出血量、住院时间明显高于FURL组患者(均P < 0.01)；对于直径≥2 cm的结石，PCNL组患者手术时间明显短于FURL组患者(P < 0.01)，而术中出血量、住院时间明显高于FURL组患者(均P < 0.01)，2组术后结石清除率比较，PCNL组患者明显高于FURL组患者(P < 0.05)；FURL组患者并发症发生率明显低于PCNL组患者(χ2=4.634，P < 0.05)。 结论 对于直径≥2 cm的肾结石患者，PCNL手术方案结石清除率高且手术时间短，可作为首选治疗方案，但术中创伤大、出血量较多且住院时间长，术后并发症发生率较高，需引起临床医师重视。对于直径 < 2 cm的肾结石患者，可选用FURL手术方案，该方案在术中对患者创伤较小且结石清除率较高，患者住院时间短，且术后并发症较少，安全性较高。今后临床应根据时机情况合理选择手术方式。 -
关键词:
- 经尿道输尿管软镜碎石取石术 /
- 经皮肾镜碎石取石术 /
- 肾结石 /
- 临床疗效
Abstract:Objective To compare the percutaneous nephroscope rubble stone extraction (percutaneous nephrostolithotomy, PCNL) and transurethral soft ureter mirror rubble stone extraction (flexible ureteroscopic lithotripsy, FURL) for clinical effect. Methods A total of 150 cases of patients with renal stones were selected from the Uropoiesis Surgical Department in the West China Hospital of Sichuan University from February 2019 to February 2020. According to the operation method, they were divided into PCNL (64 cases) and FURL (86 cases) groups. The operation time, intraoperative blood loss, hospital stay, stone clearance and statistics of the two groups of patients were observed and compared with postoperative complications. Results For calculi with a diameter of < 2 cm, there was no statistically significant difference in operation time and postoperative stone clearance rate between the two groups (all P>0.05). However, intraoperative blood loss and hospital stay time in the PCNL group were significantly higher than those in the FURL group (all P < 0.01). For calculi with a diameter of ≥2 cm, the operative time of PCNL group was significantly shorter than that of FURL group (P < 0.01). The amount of intraoperative blood loss and length of hospital stay were significantly higher than those of FURL group (all P < 0.01). The postoperative stone clearance rate of PCNL group was significantly higher than that of FURL group (P < 0.05). The incidence of complications in FURL group was significantly lower than that in PCNL group (χ2=4.634, P < 0.05). Conclusion For patients with renal calculi with a diameter of≥2 cm, the PCNL surgical scheme has a high stone clearance rate and short operation time, which can be used as the first choice of treatment. However, due to the large intraoperative trauma, large amount of bleeding, long hospital stays and high incidence of postoperative complications, clinicians should pay attention to it. For patients with renal calculi with a diameter of < 2 cm, FURL surgical protocol can be selected, which has less intraoperative trauma, higher stone clearance rate, shorter hospital stays, fewer postoperative complications and higher safety. In the future, appropriate surgical methods should be selected according to the opportunity. -
表 1 2组 < 2 cm肾结石的患者术中、术后情况比较(x ±s)
组别 例数 手术时间(min) 术中出血量(mL) 住院时间(d) 结石清除率[例(%)] PCNL组 22 51.38±3.95 68.76±2.96 7.21±1.89 19(86.36) FURL组 38 52.85±3.73 21.72±2.75 5.18±1.79 32(84.21) 统计量 1.440a 62.093a 4.148a 0.051b P值 0.155 < 0.001 < 0.001 0.822 注：a为t值，b为χ2值。 
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表 2 肾结石≥2 cm的患者术中、术后情况比较(x ±s)
组别 例数 手术时间(min) 术中出血量(mL) 住院时间(d) 结石清除率[例(%)] PCNL组 42 61.63±6.83 83.25±7.71 8.04±1.63 38(90.48) FURL组 48 92.72±6.82 32.52±5.83 6.95±1.78 33(68.75) 统计量 21.561a 34.813a 3.014a 6.349b P值 < 0.001 < 0.001 0.003 0.012 注：a为t值，b为χ2值。
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