输尿管软镜手术与微通道经皮肾镜取石术治疗 2.0～3.0 cm上尿路结石的对比研究

Comparative study of mini-percutaneous nephrolithotomy and retrograde intrarenal surgery on treating 2.0 ~ 3.0 cm upper urinary calculi

摘要:

摘要：目的??探讨逆行输尿管软镜手术（RIRS）与微通道经皮肾镜取石术（MPCNL）治疗2.0～3.0 cm上尿路结石的安全性和有效性。方法?回顾性分析2015年6月－2018年5月该院收治的64例2.0～3.0 cm上尿路结石患者临床资料，根据选择的术式分为RIRS组（n =31）和MPCNL组（n =33），观察两组患者的临床疗效。结果?所有患者手术均顺利完成。RIRS组与MPCNL组清石率比较（93.54%和96.96%），差异无统计学意义（P >0.05）；RIRS组与MPCNL组手术时间分别为（90.45±34.06）和（125.79± 34.32）min；手术后第1天血红蛋白（Hb）下降值分别为7.00（-1.00，12.00）和13.00（7.00，21.00）g/L；术后24 h视觉模拟评分（VAS）分别为（2.42±0.50）和（5.05±1.31）分；住院时间分别为（10.29±4.78）和（13.00±4.57）d；两组比较，差异均有统计学意义（P <0.05）；根据手术后并发症的Clavien-Dindo评分系统评估，两组并发症发生率比较，差异无统计学意义（P >0.05）。二期手术率RIRS组明显高于MPCNL组（58.06%和6.06%），差异有统计学意义（P <0.01）；RIRS组与MPCNL组治疗费用为（1.72±1.08）和（1.25± 0.97）万元，差异有统计学意义（P <0.05）。结论?治疗2.0～3.0 cm上尿路结石，RIRS与MPCNL均为安全有效的方法，相比于MPCNL，RIRS具有创伤小、出血更少、痛苦少、恢复快和住院时间短等优势，但RIRS组二期手术率及治疗费用明显高于MPCNL组。需根据患者的自身情况及意愿，采取个体化治疗方案。

Abstract:

Abstract: Objective?To compare the safety and efficacy of mini-percutaneous nephrolithotomy (MPCNL) and retrograde intrarenal surgery (RIRS) in treatment of 2.0 ~ 3.0 cm upper urinary tract calculi.?Method?The clinical data of 64 cases with 2.0 ~ 3.0 cm renal calculus and upper ureteral calculi from June 2015 to May 2018 was retrospectively analyzed. According to the surgical approach, the clinical data were divided into group RIRS and group MPCNL. Group RIRS (31 cases) and group MPCNL (33 cases) are performed by RIRS and MPCNL respectively, and observe the clinical effect and security of the two operative types.?Result?The surgery was successful in all the cases. There was no significant difference in total stone clearance rate between group RIRS and group MPCNL (93.54% vs 96.96%) (P > 0.05). The operation time, the hemoglobin decline of the first postoperative day, pain scores 24 h after operation, the postoperative hospital stay, and the hospitalization expenses of the group RIRS and group MPCNL were (90.45 ± 34.06) min vs (125.79 ± 34.32) min, 7.00 (-1.00, 12.00) vs 13.00 (7.00, 21.00) g/L, (2.42 ± 0.50) vs (5.05 ± 1.31), which there were statistical differences between the two groups (P < 0.05). There was no significant difference in complication rate between group RIRS and Group MPCNL according to the grades of Clavien-Dindo classification of complications after operation (P > 0.05). The rate of secondary surgery in the RIRS group was significantly higher than that in the MPCNL group (58.06% vs 6.06%), and the difference was statistically significant (P < 0.01); The comparison of treatment cost between RIRS group and MPCNL group (1.72 ± 1.08) vs (1.25 ± 0.97) was statistically significant (P < 0.05).?Conclusion?RIRS and MPCNL are safe and effective methods for minimally invasive treatment of patients with upper urinary calculi of 2.0 ~ 3.0 cm. Compared with MPCNL, RIRS has advantages of less traumatic bleeding, less pain, faster recovery, and shorter hospital stay, but the rate of second-stage surgery and treatment cost of RIRS group are significantly higher than that of MPCNL group. Therefore, the individualized treatment should be adopted according to patients’ own conditions and wishes.