南方医科大学学报

南方医科大学学报 ›› 2016, Vol. 36 ›› Issue (12): 1672-.

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分期输尿管软镜钬激光碎石术与微通道经皮肾镜碎石术治疗2~4 cm肾结石的随机对照临床研究

李建伟，王芳，蔡芳震，高宏志   

  • 出版日期:2016-12-20 发布日期:2016-12-20

Staged retrograde flexible ureteroscopic lithotripsy versus miniaturized percutaneous nephrolithotomy for renal stones of 2-4 cm in diameter: a randomized controlled trial

  • Online:2016-12-20 Published:2016-12-20

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摘要： 目的比较分期输尿管软镜/钬激光碎石术（FURS）与微通道经皮肾镜碎石术（m-PCNL）治疗2~4 cm肾结石的有效性和安 全性。方法选取我院2013年1月~2015年12月收治的符合纳入标准的肾结石患者70例，应用计算机程序随机分为A组（分期 FURS）和B组（m-PCNL），每组各35例。观察比较两组的总治疗时间、总术后住院时间、总治疗费用、治疗成功率、术后血红蛋 白下降程度和并发症发生率。结果在临床疗效方面，A、B两组的治疗成功率均为100%，两组间差异无统计学意义（P>0.05）， 但是A组的完全结石清除率为65.71%，B组为94.29%，A组明显低于B组，两组间差异有统计学意义（P<0.01）；A组无临床意义 结石残留率为34.29%，B组为5.71%，A组明显高于B组，两组间差异有统计学意义（P<0.01）。在治疗安全性方面，A组手术前 后血红蛋白下降程度为3.37±1.56 g/L，B组为11.93±2.24 g/L，A组明显低于B组，两组间差异有统计学意义（P<0.01）。A组并发 症发生率为6.25%，B组为9.37%，两组间差异无统计学意义（P>0.05），轻微并发症A组出现1例为发热，B组出现2例为自限性 血尿；主要并发症A组出现1例为输尿管石街，B组出现1例为输血。A组两次治疗的总治疗时间为4.06±1.11周，B组为1.26± 0.47周，A组明显长于B组，两组间差异有统计学意义（P<0.01）；A组的总术后住院时间为3.66±1.29 d，B组为5.13±0.43 d，两组 间差异无统计学意义（P>0.05）；在总治疗费用方面，A组为54 291.00±6149.00元，B组为23 482.00±2317.00元，A组明显高于B 组，两组间差异有统计学意义（P<0.01）。结论FURS对于2~4 cm肾结石有良好的疗效和安全性，分期手术对提高较大负荷肾 结石的完全结石清除率是必要的，先进的技术设备和丰富的手术经验是治疗成功的关键。

Abstract: Objective To compare the efficacy and safety of staged retrograde flexible ureteroscopic lithotripsy (FURS) and miniaturized percutaneous nephrolithotomy (m-PCNL) for treatment of renal stones of 2-4 cm in diameter. Methods This randomized controlled trial was conducted in 70 patients with renal stones of 2-4 cm in diameter admitted in our hospital between January 2013 and December 2015. The patients were randomized to receive staged FURS (35 cases) or m-PCNL (35 cases), and the total treatment time, total hospital stay after procedure, total medical cost, treatment success, decrease in hemoglobin level and complications were compared between the two groups. Results The treatment success rate was 100% in both groups, but the complete stone-free rate was significantly lowered in FURS group than m-PCNL group (65.71% vs 94.29%, P<0.01). The average decrease in hemoglobin level was 3.37±1.56 g/L in FURS group and 11.93±2.24 g/L in m-PCNL group (P< 0.01). The overall complication rates in the two groups were 6.25% and 9.37%, respectively (P>0.05). Minor complications (grade I by Clavien-Dindo classification) occurred in one case in FURS group (fever) and two cases in m-PCNL group (self-limiting hematuria); major complications (grade II) occurred in one case in FURS group (steinstrase) and one case in m-PCNL group (blood transfusion). In staged FURS and m-PCNL groups, the mean total treatment time was 4.06±1.11 vs 1.26± 0.47 weeks (P<0.01), the mean hospital stay after procedure was 3.66 ± 1.29 vs 5.13 ± 0.43 days (P<0.01), and the mean total medical cost was ￥54 291.00±6149.00 vs ￥23 482.00±2317.00 (P<0.01), respectively. Conclusion FURS is safe and effective for treatment of renal stones of 2-4 cm in diameter, and a staged procedure is necessary to achieve a stone-free status for large calculi. Both sophisticated equipment and rich surgical experience are essential to ensure treatment success.