摘要
目的比较输尿管软镜(f-URS)与微通道经皮肾镜碎石取石术(mPCNL)治疗1~2 cm多发性肾结石的疗效。方法回顾性分析2022年1月至2024年6月在中南大学湘雅医学院附属株洲医院接受f-URS和mPCNL治疗的1~2 cm多发性肾结石患者的临床资料,并应用倾向评分匹配法(PSM)进行匹配,共纳入120例患者,基于结石数量(≤3枚与>3枚)将其分为两组。比较两种手术方式的安全性与有效性。结果f-URS组术后住院时间[(3.05±1.52)d vs.(7.63±1.48)d,t=15.060,P<0.001]、手术时间[(84.91±38.92)min vs.(100.58±29.29)min,t=2.370,P=0.027]及并发症发生率[8.8%vs.30.0%,χ^(2)=7.530,P=0.006]方面显著优于m PCNL组。两组结石清除率比较差异无统计学意义(P>0.05)。结石数量≤3时,f-URS组手术时间[(77.59±40.73)min vs.(100.04±28.56)min,t=2.500,P=0.015]和并发症[6.5%vs.23.1%,χ^(2)=4.180,P=0.041]发生率均显著优于mPCNL组;结石数量>3时,两种手术方式的差异无统计学意义(P>0.05)。结论对于1~2 cm的多发性肾结石,当结石数量≤3时,f-URS可达到与mPCNL相同的结石清除率,同时具有更短的术后恢复时间、更短的手术时间和较低的并发症风险。当结石数量>3时,两种手术方式的疗效相似。
Objective To compare the therapeutic efficacy of flexible ureteroscopy(f-URS)and mini-percutaneous nephrolithotomy(mPCNL)in the treatment of multiple renal calculi sized 1–2 cm.Methods The clinical data of patients with 1–2 cm multiple renal calculi who underwent f-URS or mPCNL at Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University from January 2022 to June 2024 were retrospectively analyzed.Propensity score matching(PSM)was applied for cohort matching,and a total of 120 patients were enrolled.All patients were divided into two subgroups according to the number of calculi(≤3 vs.>3 calculi).The safety and effectiveness of the two surgical approaches were compared.Results The f-URS group showed significant advantages over the mPCNL group in terms of postoperative hospital stay[(3.05±1.52)d vs.(7.63±1.48)d,t=15.060,P<0.001],operative time[(84.91±38.92)min vs.(100.58±29.29)min,t=2.370,P=0.027],and complication rate[8.8%vs.30.0%,χ^(2)=7.530,P=0.006].There was no statistically significant difference in stone-free rate between the two groups(P>0.05).In the subgroup with≤3 calculi,the f-URS group had shorter operative time[(77.59±40.73)min vs.(100.04±28.56)min,t=2.500,P=0.015]and lower complication rate[6.5%vs.23.1%,χ^(2)=4.180,P=0.041]compared with the mPCNL group.However,no statistically significant differences were observed between the two surgical approaches in the subgroup with>3 calculi(P>0.05).Conclusion For multiple renal stones measuring 1–2 cm,f-URS can achieve stone-free rates comparable to those of mPCNL when the number of stones is≤3,while offering shorter postoperative recovery,reduced operative time,and a lower risk of complications.When the number of stones exceeds 3,the clinical efficacy of the two surgical approaches appears to be comparable.
作者
柳成孟
唐翔宇
王芸
瞿根义
李巨鹏
Liu Chengmeng;Tang Xiangyu;Wang Yun;Qu Genyi;Li Jupeng(Operating Room,Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Hunan,Zhuzhou 412007,China;Department of Urology,Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University,Hunan,Zhuzhou 412007,China)
出处
《微创泌尿外科杂志》
2025年第6期361-365,共5页
Journal of Minimally Invasive Urology
基金
湖南省自然科学基金项目(2024JJ7660)。
关键词
输尿管软镜
微通道经皮肾镜取石术
上尿路结石
倾向评分匹配
碎石术
flexible ureteroscopy
mini-percutaneous nephrolithotomy
upper urinary tract calculi
propensity score matching
lithotripsy
