末端可弯曲型输尿管镜与PCNL联合钬激光治疗直径≤2cm肾盏结石的对比研究

摘要

目的 对比分析末端可弯曲型输尿管镜(F-URS)与经皮肾镜取石(PCNL)联合钬激光在治疗直径≤2 cm肾盏结石中的疗效与安全性.方法 收集93例直径≤2 cm肾盏结石患者的临床资料,其中46例采用F-URS联合钬激光碎石治疗(F-URS组),47例采用PCNL联合钬激光碎石治疗(PCNL组).比较2组在手术时间、一期碎石成功率、结石清除率、手术并发症、术后住院时间及住院总费用的差异.结果 F-URS组46例患者的一期碎石成功40例(87%),PCNL组一期碎石成功44例(94%).2组的肾上盏、中盏结石的一期碎石成功率及结石清除率比较差异均无统计学意义(P均>0.05).F-URS组的手术时间长于PCNL组、下盏结石一期碎石成功率低于PCNL组(P均<0.05).与PCNL组相比,F-URS组的手术并发症发生率低、术后住院时间短及住院费用低(P均<0.05).结论 F-URS联合钬激光碎石治疗直径≤2 cm肾上盏、中盏结石的疗效与PCNL联合钬激光碎石相近,且具有创伤小、并发症少、住院时间短及住院费用低等优势.%Objective To compare the clinical efficacy and safety between ureteroscope using a newly-designed flexible deflectable tip (F-URS) and percutaneous nephrolithotomy (PCNL) combined with holmium laser in the treatment of calyceal calculus ≤2 cm in size.Methods Clinical data of 93 patients diagnosed with calyceal calculus (≤2 cm) were collected.Among them,46 received F-URS combined with holmium laser (F-URS group),and 47 underwent PCNL in combination with holmium laser (PCNL group).The operation time,success rate during the first stage,clearance rate of calculus,postoperative complications,postoperative hospital stay,overall hospitalization expenses were statistically compared between two groups.Results In the F-URS group,the success rate during the first stage was 87% (40/46),and 94% (44/47) in the PCNL group.No statistical significance was identified in the success rate during the first stage and clearance rate of the upper and middle calyceal calculus between two groups (both P>0.05).In the F-URS,the operation time was significantly longer,and the success rate of the lower calyceal calculus during the first stage was considerably lower than those in the PCNL group (both P<0.05).Compared with the PCNL group,the incidence of surgical complications was dramatically lower,postoperative length of hospital stay was significantly shorter and the hospitalization expense was significantly less in the F-URS group (all P<0.05).Conclusions Compared with PCNL in combination with holmium laser,combined application of F-URS and holmium laser yields identical clinical efficacy in treating the upper and middle calyceal calculus ≤2 cm in size,presenting with multiple advantages,such as less trauma and complications,shorter length of hospital stay and lower hospitalization expense.