不同方式治疗2～4 cm鹿角型肾结石的临床疗效

Clinical efficacy of different treatments for 2～4 cm staghorn kidney stones

摘要:

目的 比较双镜联合（电子膀胱肾盂镜协同经皮肾镜）、输尿管软镜（RIRS）与单独使用经皮肾镜取石术（PCNL）处理2～4 cm鹿角型肾结石的临床安全性及有效性。方法 回顾性分析南华大学附属第一医院2013年12月－2016年12月收治的130例2～4 cm鹿角型肾结石患者的临床资料，其中包括双镜联合组40例、输尿管软镜治疗组（RIRS组）42例和单独使用经皮肾镜治疗组（PCNL组）48例。分析整理3组的基线数据，并对各组间围术期资料进行临床对比分析。结果 3组一期结石清除率、住院时间、手术时间、住院费用和第三方患者满意度等围术期资料比较，差异均有统计学意义（P < 0.05）。结论 与PCNL组比较，使用双镜联合治疗2～4 cm鹿角型肾结石具有结石清除率高和患者满意度高的特点，而使用RIRS则具有更加微创化和术后恢复快等优势。术者可以根据医院技术设备结合患者自身条件和意愿，对于2～4 cm范围的鹿角型肾结石选择个性化治疗方案。

Abstract:

Objective The clinical safety and effectiveness of dual-mirror combination (electronic bladder pyeloscope and percutaneous nephroscope), soft ureteroscope and percutaneous nephroscope alone for treatment of 2～4 cm staghorn kidney stones were compared.Methods 130 patients with 2～4 cm staghorn nephrolithiasis collected clinically were retrospectively analyzed, including 40 cases in double mirror combined group, 42 cases in soft ureteroscope treatment group and 48 cases in the percutaneous nephroscope treatment group. Baseline data of the three groups were analyzed and clinical comparison analysis was performed on the perioperative data among the groups.Results The perioperative data such as stone clearance rate, length of hospital stay, operation time, hospital costs and third-party patient satisfaction among the three groups had significant statistical significance (P < 0.05).Conclusion Compared with the single percutaneous nephroscope treatment group, the use of dual-mirror combination for 2～4 cm staghorn stones has the characteristics of high stone clearance and high patient satisfaction. The use of retrograde intrarenal surgery has the advantages of more minimally invasive and quick recovery after surgery. The surgeon can choose a personalized treatment plan for staghorn kidney stones in the range of 2～4 cm according to the technical equipment of the hospital and the patient's own conditions and wishes.