摘要
目的 比较超微经皮肾镜（SMP）和输尿管软镜（FURS）治疗肾下极结石的有效性和安全性.方法 回顾性分析2015年3月至2017年4月手术治疗的195例肾下极结石患者的临床资料.男120例,女75例.年龄19～ 68岁,平均45岁.分为FURS组（112例）和SMP组（83例）.FURS组结石累计直径（CSD） 15 ～24 mm（20.3±3.9） mm;SMP组CSD为15 ～28 mm（20.7 ±3.2）mm,两组结石大小比较差异无统计学意义（P＞0.05）.比较两种术式的手术时间、术后首日血红蛋白（Hb）丢失量、术后首日血降钙素原及超敏C反应蛋白（hs-CRP）、术后首日血白细胞（WBC）计数、术后住院时间、术后第1天及1个月的清石率、并发症发生情况等.结果 FURS组手术时间28 ～ 62（55.3±7.3） min;SMP组手术时间为15～55 min（40.5 ±6.8）min,差异有统计学意义（P＜0.05）.SMP组术后次日晨Hb丢失量为4～16g/L（7.7±4.2）g/L;FURS组为2～11 g/L（5.1±2.8）g/L,两组比较差异有统计学意义（P＜0.05）.术后第1天SMP组hs-CRP为7.4～29.1 mg/L（17.2 ±7.1）mg/L;降钙素原0.1 ～ 1.2 ng/ml（0.6±0.3） ng/ml;血WBC计数6.3～ 18.1＆#215;109/L（12.6±3.2）＆#215;109/L.术后第1天FURS组hs-CRP 6.9 ～37.8 mg/L（26.4±6.4）mg/L;降钙素原0.2 ～1.4 ng/ml（0.9 ±0.4）ng/ml;血WBC计数9.5 ～ 21.7＆#215;109/L（14.8±2.9）＆#215;109/L.两组的CRP、降钙素原、血WBC计数比较差异有统计学意义（均P＜0.05）.FURS组和SMP组术后第1天清石率分别为80.4％（90/112）和89.2％（74/83）,术后1个月清石率分别为85.7％ （96/112）和96.4％（80/83）,差异有统计学意义（均P＜0.05）.FURS组术后住院时间2～5 d（2.3±1.2）d;SMP组术后住院时间3～6 d（3.7±1.6）d,差异有统计学意义（P＜0.05）.SMP组术后第1天视觉评分量表（VAS）疼痛评分为0～3分（2.1±0.4）分;Bruggrmann舒适评分（BCS）为2～4分（3.2±0.7）分;FURS组术后第1天VAS疼痛评分为0～3分（1.9±0.5）分;BCS评分为2～4分（2.8±0.5）分.两组的BCS评分、VAS评分比较差异无统计学意义（均P ＞0.05）.结论 SMP和FURS均是治疗CSD 20 mm左右肾下盏结石有效的方法.与FURS相比,SMP的清石率较高、手术风险较低.
Objective To compare the safety and efficacy between flexible ureteroseope lithtripsy （FURS） and super-mini-percutaneous Nephrolithotomy （SMP） in the treatment of lower calyx calculus.Methods From Mar 2015 to Apr 2017,120 male and 75 female patients were accepted FURS （n =112）or SMP（n =83） in our hospital.Their average age was 45 years old,ranged from 19 to 68 years old.The cumulative stone diameter ranged from 15-24 mm （mean 20.3 ± 3.9 mm） in FURS group and ranged from 15-28 mm （mean 20.7 ± 3.2mm） in SMP group.There were no significant differences between the groups FURS and SMP in the stone size （P 〉 0.05）.Operative duration,postoperative hospital stay,complication rate,and stone-free rate（one day or one month after procedure） were recorded and compared.Results The operative time ranged from 28 to 62 min （mean 55.3 ± 7.3min） in FURS group and ranged from 15 to 55 min （mean 40.5 ± 6.8 min） in SMP group （P 〈 0.05）.One day after the operation,CRP was 7.4-29.1 （mean 17.2 ± 7.1） mg/L in group SMP,which was lower than that in group FURS 6.9-37.8 （mean 26.4 ± 6.4） mg/L （P 〈 0.05）.And the procalcitonin and peripheral leukocyte count was 0.1-1.2 （mean 0.6± 0.3）ng/ml and 6.3-18.1（mean 12.6± 3.2） ＆#215; 109/L respectively,which was lower than that in group FURS O.2-1.4 （mean 0.9 ± 0.4） ng/ml and 9.5-21.7 （mean 14.8 ± 2.9） ＆#215; 109/L respectively （P 〈 0.05）.One day after the operation,the stone free rate was 80.4% （90/112） in group FURS,which was lower than that in group SMP 89.2% （74/83） （P 〈 0.05）.And one month after the operation,the stone free rate was 85.7% （96/112） in group FURS,which was lower than that in group SMP 96.4% （80/83） （P 〈 0.05）.Postoperative hospitalization stay ranged from 2 to 5 days （mean 2.3 ± 1.2 days） and ranged from 3 to 6 days （3.7 ± 1.6 days） in FURS and SMP group,respectively （P 〈 0.05）.The scores of Visual Analogue Scale （VAS） ranged from 0 to 3 （mean 2.1 ± 0.4） and ranged from 0 to 3 （mean 1.9 ± 0.5） in FURS and SMP group,respectively （P 〈 0.05）.And the scores of Bruggrmann comfort scale （BCS） ranged from2to4 （mean 3.2 ±0.7） and ranged from 2 to4 （2.8 ±0.5） in FURS and SMP group,respectively（P 〈 0.05）.Conclusions Both SMP and FURS are efficacy and safe surgical alteration for patients with renal and renal lower calyx calculus of CSD about 2cm.The SMP could have some advantages such as the better stone free rate and acceptable complieation rate.
作者
廖国栋
俞蔚文
章越龙
吕佳
毛祖杰
何翔
Liao Guodong Yu Weiwen Zhang Yuelong Lyu Jia Mao Zujie He Xiang(Department of Urology, Zhejiang Provincal People＇s Hospital, People＇s Hospital of Hangzhou Medical College, Hangzhuo 310014, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2017年第9期667-670,共4页
Chinese Journal of Urology
基金
浙江省重大科技专项计划项目（2014C03047-1）
关键词
肾及输尿管结石
软性输尿管镜
超微经皮肾镜
疗效
安全性
Renal and ureteral calculus
Flexible ureteroseope
Super-mini-percutaneous Nephrolithotomy
Safety
Effectivity
