3 cm以内肾结石微创治疗方案的选择探索*

Microinvasive surgery options for renal calculi within 3 cm*

摘要:

探索3 cm以内肾结石微创治疗方案的选择方式。方法 回顾性分析该院2016年5月－2018年5月符合纳入标准的70例肾结石患者的临床资料，接受经皮肾镜取石术（PCNL）的患者34例，接受输尿管软镜碎石术（FURL）的患者36例。通过比较接受两种微创手术方式患者的手术时间、术后住院时间、手术出血率、结石清除率和术后C-反应蛋白（CRP）升高率等观察指标的差异，评价两种手术方式治疗肾结石的部分临床疗效。结果 两组患者的一般资料比较，差异无统计学意义（P >0.05）。两组患者的手术时间、结石清除率和术后发热率比较，差异均无统计学意义（P >0.05）；PCNL组术后住院时间（9.06±2.35）d长于FURL组术后住院时间（3.94±1.26）d，PCNL组术后出血率及术后CRP升高率均高于FURL组，两组比较，差异均有统计学意义（P <0.05）。结论 两种针对3 cm以内肾结石的微创治疗方案，PCNL具有创伤小、疗效确切等优点，但治疗过程中会伴有较高的术中和术后出血、术后感染等风险；FURL治疗肾结石的特点是几乎接近无创，具有出血少，疗效确切、术后感染率低和术后患者恢复快等诸多优点。在两种手术方式均可作为备选方案的情况下，FURL治疗3 cm以内肾结石更具有优势，值得推荐。

Abstract:

To explore options of microinvasive surgery for renal calculi within 3 cm. Methods We retrospectively analyzed the clinical data of 70 patients with renal calculi who met the inclusion criteria from May 2016 to May 2018, including 34 patients in the PCNL group and 36 patients in the FURL group. Then evaluate the clinical efficacy of the two surgical methods for treating renal calculi by comparing the operative time, postoperative hospital stay, surgical bleeding rate, stone clearance rate, postoperative C-reactive protein (CRP) elevation rate and other observational parameters. Results There was no statistical significance in general data (gender, age, maximum diameter of stone), operation time, stone clearance rate and proportion of fever after surgery between the two groups of patients with renal calculi (P > 0.05). The postoperative hospital stay in the PCNL group was longer than that in the FURL group, they were (9.06 ± 2.35) day and (3.94 ± 1.26) day, respectively. The surgical bleeding rate in the PCNL group, and the postoperative C-reactive protein (CRP) increase rate were higher than those in the FURL group. The difference between the two groups was statistically significant (P < 0.05). Conclusion For the two groups of minimally invasive treatments for renal calculi within 3 cm. Percutaneous nephrolithotomy (PCNL) has the advantages of less trauma, definite curative effect. However, the risk of intraoperative and postoperative bleeding, postoperative infection may be associated with the course of treatment. The flexible ureteroscope lithotripsy (FURL) treatment of renal calculi is almost non-invasive. And it has the advantages of less bleeding, definite curative effect, lower postoperative infection rate and rapid postoperative recovery. In the case that both surgical methods can be used as an alternative, flexible ureteroscope lithotripsy (FURL) has a certain advantage in treatment of renal calculi within 3 cm. It is worth recommending.