体外冲击波碎石与输尿管软镜治疗10～20 mm肾下盏结石的对照研究

Flexible ureterorenoscopy vs extracorporeal shock wave lithotripsy for inferior calyceal calculi of 10 ~ 20 mm

摘要:

比较输尿管软镜（FURS）下钬激光碎石术与体外冲击波碎石（ESWL）治疗10～20 mm肾下盏结石的主观和客观效果。方法 回顾性分析2013年9月-2016年9月该院就诊的FURS下钬激光碎石和ESWL治疗10～20 mm肾下盏结石112例，对比两组再次治疗率、并发症发生率、结石清除率，以及患者主观评分。结果 FURS组结石清除率明显高于ESWL组（86.1% vs 61.8%，P <0.05），ESWL组再次治疗率明显高于FURS组（44.7% vs 8.3%，P <0.05），并发症发生率FURS组高于ESWL组（11.1% vs 7.9%），但两组比较差异无统计学意义（P >0.05）。患者总体满意评分[（2.92±1.24）vs（2.07±1.35）分，P <0.05]和排尿症状评分[（3.87±0.64）vs（2.23±0.73）分，P <0.05]，FURS组均高于ESWL组，另有更多的人愿意再次接受FURS的治疗（83.3% vs 55.3%，P <0.05）。结论 FURS因为更高的结石清除率和较低的再次手术率优于ESWL，并且FURS能获得更高的患者满意度。

Abstract:

To compare the subjective and objective outcomes of flexible ureterorenoscopy (F-URS) and extracorporeal shock wave lithotripsy (ESWL) for the treatment of inferior calyceal calculi between 10 to 20 mm. Method A retrospective analysis was performed for inferior calyceal calculi between 10 to 20 mm at our institution on a total of 112 patients treated with holmium laser lithotripsy or ESWL from September 2013 to September 2016. Retreatment rate, complications, stone clearance rate and subjective patient-reported outcomes were compared. Result Stone clearance rate was significantly higher in F-URS group compared with ESWL group (86.1% vs 61.8%, P < 0.05). Retreatment rate (44.7% vs 8.3%, P < 0.05) was higher in ESWL. There was no significant difference in complication (11.1% vs 7.9%, P > 0.05). Overall satisfaction score [(2.92 ± 1.24) vs (2.07 ± 1.35), P < 0.05] and voiding symptom score [(3.87 ± 0.64) vs (2.23 ± 0.73), P < 0.05)] were significantly higher in F-URS than ESWL. More patients in F-URS were willing to undergo the procedure again (83.3% vs 55.3%, P < 0.05). Conclusion For the treatment of intermediate size inferior calyceal calculi, F-URS is superior to ESWL in terms of stone clearance rate, retreatment rate and subjective satisfaction.