顺行软性输尿管镜辅助经皮肾镜取石术治疗鹿角形肾结石的效果分析

Efficacy analysis of antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy in the treatment of staghorn calculus

摘要:

目的 探讨单次经皮肾镜取石术（SPCNL）和顺行软性输尿管镜辅助经皮肾镜取石术（AFPCNL）治疗鹿角肾形结石的疗效和安全性。方法 纳入2021年1月－2024年12月该院收治的鹿角形肾结石患者160例，采用随机数表法分为SPCNL组（81例）和AFPCNL组（79例）。比较两组患者手术相关情况和临床结局。亚分组分析第1组（结石分支数 < 5）和第2组（结石分支数 ≥ 5）的手术相关情况和临床结局。结果 与SPCNL组相比，AFPCNL组结石清除率更高，所需经皮肾通道更少，手术时间更短，差异有统计学意义（P < 0.05）。AFPCNL组手术分期率更低，尤其是在结石分支数≥5中，差异均有统计学意义（P < 0.05）。SPCNL组和AFPCNL组血红蛋白水平变化和输血率比较，差异均无统计学意义（P > 0.05）。两组患者围手术期并发症发生率比较，差异无统计学意义（P > 0.05）。结论 AFPCNL治疗鹿角形肾结石的结石清除率更高，与SPCNL相比，AFPCNL需要的经皮肾穿刺通道更少，分期手术率更低，手术时间更短，尤其是在结石分支数 ≥ 5的患者中更具优势。

Abstract:

Objective To explore the efficacy and safety of single percutaneous nephrolithotomy (SPCNL) and antegrade flexible ureteroscopy-assisted percutaneous nephrolithotomy (AFPCNL) in the treatment of staghorn calculus.Methods A total of 160 patients with staghorn calculus who met the study criteria and were admitted to our hospital from January 2021 to December 2024 were enrolled, they were randomly divided into the SPCNL group (81 cases) and the AFPCNL group (79 cases). The overall differences in surgical parameters, and clinical outcomes between the SPCNL group and the AFPCNL group were compared. Then, the patients were divided into two subgroups: Group 1 (number of stone branches < 5) and group 2 (number of stone branches ≥ 5), and the differences in clinical and surgical parameters between the two subgroups were compared.Results Compared with the SPCNL group, the AFPCNL group had a higher stone clearance rate, required fewer percutaneous accesses, and shorter operative time, the differences were statistically significant (P < 0.05). In addition, the AFPCNL group had a lower staged surgery rate, especially in patients with stone branches ≥5, the difference was statistically significant (P < 0.05). There were no statistical differences in hemoglobin level changes and blood transfusion requirements between the SPCNL group and AFPCNL group (P > 0.05). The incidence of perioperative complications was not statistically significant between the two groups (P > 0.05).Conclusion AFPCNL for staghorn calculus has a higher stone clearance rate. Compared with SPCNL, AFPCNL requires fewer multiple percutaneous accesses, a lower staged surgery rate, and shorter operative time, especially in patients with ≥5 stone branches.