摘要
目的比较超微经皮肾镜（UMP）与输尿管软镜（RIRS）治疗中等大小（1～2 cm）肾下盏结石的疗效及并发症。
方法选取我院2015年3月至2016年12月收治的肾下盏结石患者资料进行前瞻性分析。结石大小为1～2 cm，排除合并中上盏结石的患者。将患者按随机数字表法分为2组：UMP组，操作通道F14，置入直径约1 mm超微肾镜，连接200 μm钬激光将结石击碎后以涡流形式冲出；RIRS组，术前留置F6双J管扩张2周，术中先置入软镜鞘，连接输尿管软镜，置入200 μm钬激光碎石，将结石粉末化。比较两组的结石清除率、术中及术后情况。
结果UMP组共50例，男28例，女22例；年龄（43.4±7.9）岁，范围23～57岁；结石大小（14.5±3.0）mm，范围10～22 mm；18例合并轻至中度肾积水。RIRS组50例，男31例，女19例；年龄（44.5±8.3）岁，范围22～61岁；结石大小（13.7±3.1）mm，范围10～21 mm；16例合并有轻至中度肾积水。两组术前资料比较差异无统计学意义（P〉0.05）。UMP组和RIRS组手术时间分别为（26.5±6.1）min和（43.3±6.3）min，术后血红蛋白下降值分别为（7.8±3.3）g/L和（3.1±3.4）g/L，差异有统计学意义（P〈0.05）。UMP组一次性碎石成功率94.0%（47/50）高于RIRS组的72.0%（36/50），差异有统计学意义（P〈0.05）。UMP组和RIRS组住院时间分别为（4.3±1.3）d和（3.2±1.2）d，迟发性出血发生率分别为8.0%（4/50）和0，术后发热率分别为16.0%（8/50）和12.0%（6/50），差异无统计学意义（P〉0.05）。
结论UMP与RIRS均是治疗中等大小（1～2 cm）肾下盏结石安全、有效的方法。UMP较RIRS取石成功率更高、手术时间明显缩短，但术中出血量明显增多。
ObjectiveTo compare the effectiveness and safety of ultramini percutaneous nephrolithotomy （UMP） and retrograde intrarenal surgery （RIRS） in treatment of moderate-sized （about 1-2 cm） renal lower caliceal calculi.
MethodsFrom March 2015 to December 2016, patients in our hospital scheduled for surgery due to renal lower caliceal calculi with the greatest diameter of 10-22 mm were prospectively analyzed. Patients were randomized into two groups according to the random number table. Group UMP＇s operational channel was only F14 and the nephroscope＇s diameter was 1 mm. 200 μm holmium laser lithotripsy was used to break the stones which was rushed out by eddy cuurent. In Group RIRS, all patients needed placing a F6 double J stent preoperatively for two weeks.A flexible ureteroscope sheath required imbedding intraoperatively.The stones were smashed by 200 μm holmium laser lithotripsy through the WOLF flexible ureteroscope.The intraoperative and postoperative datas including stone-free status and the complications were compared.
Results100 patients were enrolled in the study 50 patients in Group UMP, 28 were male and 22 were female, mean age was 43.4±7.9 years old.Mean stone size was 14.5±3.0 mm（range 10-22 mm）. Among them, 18 cases were complicated with mild and moderate hydronephrosis. The other 50 cases were allocated to Group RIRS, including 31 males and 19 females.Their mean age was 44.5±8.3 years old and mean stone size was 13.7±3.1mm （range 10-21 mm）. Among them, 16 cases were complicated with mild and moderate hydronephrosis.No statistically significant difference were seen between the two groups（P〉0.05）. After three months’ follow-up, one-time stone free rate（SFR） of UMP group was 94.0%（47/50）, which was significantly more superior than the 72.0%（36/50） of the RIRS group（P〈0.05）. The intraoperative decrease in hemoglobin were（7.8±3.3）g/L vs.（3.1±3.4）g/L, and operating time（ 26.5±6.1）min vs. （43.3±6.3）min. Significant differences were also seen between the two groups（P〈0.05）. There was more blood loss and less operating time in the group of UMP.The hospital stay, delayed hemorrhage and postoperative fever between the UMP and RIRS groups were （4.3±1.3）d vs.（3.24±1.21）d, 8.0%（4/50）vs. 0（0/50）, 16.0%（8/50）vs. 12.0%（6/50） respectively. No significant differences were seen（P〉0.05）.
ConclusionsBoth UMP and RIRS procedures are effective and safe in the treatment of moderate-sized renal lower caliceal calculi. Compared with RIRS, UMP may be more effective and has less operating time, however wtih more intraoperative blood loss.
作者
王世先
杨水法
王飞
杨恩明
潘东山
黄旭锋
王俊龙
谢晓强
李青楠
林晓翰
Wang Shixian, Yang Shuifa, Wang Fei , Yang Enming , Pan Dongshan , Huang Xufeng , Wang Junlong , Xie Xiaoqiang , Li Qingnan , Lin Xiaohan.(Department of Urology, Xiamen Second Hospital, Xiamen 361021, Chin)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第3期209-213,共5页
Chinese Journal of Urology
关键词
肾下盏结石
超微经皮肾镜碎石术
输尿管软镜
钬激光
前瞻性研究
Renal lower caliceal calculi
Ultra-mini percutaneous nephrolithotomy
Flexible ureterorenoscope
Holmium laser
Prospective study
作者简介
通信作者：王世先，Email：qy_wangshixian@163．com
