输尿管软镜与经皮肾镜碎石术治疗上尿路结石的临床疗效对比研究

Comparison of the clinical efficacy of flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy for upper urinary tract calculus

摘要:

目的 比较逆行输尿管软镜碎石术（RIRS）联合头端可弯负压吸引鞘（S-UAS）与经皮肾镜取石术（PCNL）治疗多发肾和/或输尿管上段结石的安全性及有效性。方法 回顾性分析2023年1月－2025年5月于该院接受RIRS联合S-UAS或PCNL治疗的81例多发肾和/或输尿管上段结石患者的临床资料，根据不同手术方法分为RIRS组（43例）与PCNL组（38例）。观察两组围手术期指标、疼痛程度、肾功能、结石清除率（SFR）和不良反应发生情况。结果 PCNL组手术时间明显短于RIRS组，而RIRS组术中出血量明显少于PCNL组，术后住院时间明显短于PCNL组，术后24 h视觉模拟评分法（VAS）评分明显低于PCNL组，差异均有统计学意义（P < 0.05）。两组术后24 h血红蛋白（Hb）水平、术前和术后24 h血尿素氮（BUN）和肌酐（Cr）水平比较，差异均无统计学意义（P > 0.05）。亚分组中，两组结石直径 ≤ 2.0 cm的SFR比较，差异无统计学意义（P > 0.05）；直径 > 2.0 cm的结石中，PCNL组SFR明显高于RIRS组，差异有统计学意义（P < 0.05）。两组并发症发生率比较，差异无统计学意义（P > 0.05）。结论 S-UAS联合RIRS与PCNL治疗多发上尿路结石各具优势。S-UAS联合RIRS术中出血量更少，术后住院时间更短；而针对直径 > 2.0 cm的结石，PCNL具有更高的SFR。临床实践中，应结合患者具体病情综合考量，个体化选择最优手术方案。

Abstract:

Objective This study aims to compare the safety and efficacy of retrograde intrarenal surgery (RIRS) combined with a flexible-tip suction ureteral access sheath (S-UAS) versus percutaneous nephrolithotomy (PCNL) in the management of multiple renal and/or upper ureteral calculus.Methods A retrospective analysis was conducted on the clinical data of 81 patients with multiple renal and/or upper ureteral calculus who received RIRS combined with S-UAS or PCNL in this hospital from January 2023 to May 2025. They were divided into the RIRS group (43 cases) and the PCNL group (38 cases) according to different surgical methods. Observe the perioperative indicators, pain degree, renal function, stone free rate (SFR) and the occurrence of adverse reactions in the two groups.Results The operation time of the PCNL group was significantly shorter than that of the RIRS group, while the intraoperative blood loss of the RIRS group was significantly less than that of the PCNL group, the postoperative hospital stay was significantly shorter than that of the PCNL group, and the visual analogue scale (VAS) score at 24 hours after surgery was significantly lower than that of the PCNL group. The differences were all statistically significant (P < 0.05). There were no statistically significant difference in the hemoglobin (Hb) level 24 hours after the operation, levels of blood urea nitrogen (BUN) and creatinine (Cr) before and 24 h after the operation between the two groups (P > 0.05). In the subgroups, there was no statistically significant difference in the SFR between the two groups with stone diameters ≤ 2.0 cm (P > 0.05). Among the stones with a diameter > 2.0 cm, the SFR in the PCNL group was significantly higher than that in the RIRS group, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the incidence of complications between the two groups (P > 0.05).Conclusion S-UAS combined with RIRS and PCNL each present distinct advantages in the treatment of multiple upper urinary tract calculus. S-UAS-assisted RIRS is associated with less intraoperative blood loss and a shorter postoperative hospital stay. By contrast, PCNL achieves a higher SFR for calculus with a diameter greater than 2.0 cm. In clinical practice, the optimal surgical procedure should be determined through comprehensive evaluation of the patient’s individual condition and selected on an individualized basis.