输尿管软镜与微通道经皮肾镜治疗老年患者10～20 mm肾下盏结石对比研究
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摘要
目的探讨输尿管软镜(f-URS)与微通道经皮肾镜(m-PCN)治疗老年患者10～20 mm肾下盏结石的临床疗效。方法选取自2015年1月至2017年12月武警辽宁总队医院收治的年龄≥60岁单侧肾下盏结石的98例患者为研究对象。根据手术方法不同分为f-URS组(n=48)和m-PCN组(n=50),比较两组患者的手术时间、术后并发症的发生情况、住院时间及出院清石率等。结果 f-URS组患者的手术时间长于m-PCN组,但术后血红蛋白下降程度低于m-PCN组,术后住院时间短于m-PCN组,差异均有统计学意义(P<0.05)。两组患者术后高热、出血等并发症的发生率比较,差异无统计学意义(P>0.05)。f-URS组和m-PCN组患者出院清石成功率分别为89.6%(43/48)和92.0%(46/50),两组间比较,差异无统计学意义(P>0.05)。结论 f-URS与m-PCN治疗老年患者10～20 mm肾下盏结石各有优势,具体手术方式需要根据术者和患者的情况进行选择。
Objective To investigate the clinical efficacy and complications of flexible ureteroscopic lithotripsy(f-URS)and miniaturized percutaneous nephrolithotomy(m-PCN)in the treatment of 10-20 mm lower-calyx calculi in elderly patients.Methods A retrospective study was performed on 98 cases of patients more than 60 years old with lower-calyx calculi who were admitted from January 2015 to December 2017.The patients were divided into the f-URS group(n=48)and the m-PCN group(n=50)according to different surgical methods,and the operation time,occurrence of postoperative complications,length of stay and discharge stone removal rate of the patients in the two groups were compared.Results The operative time of patients in the f-URS group was longer than that of the m-PCN group,while the degree of postoperative hemoglobin decline was lower than that of the m-PCN group,and the postoperative hospitalization time was shorter than that of the m-PCN group,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of postoperative complications such as high fever and bleeding between the two groups(P>0.05).The success rate of discharge lithotomy in the f-URS group and m-PCN group was 89.6%(43/48)and 92.0%(46/50),respectively.The success rate of discharge lithotomy was no statistically significant difference between the two groups(P>0.05).Conclusion F-URS and m-PCN have their own advantages in the treatment of lower-calyceal calculi of 10-20 mm kidney in elderly patients,and the specific operation method needs to be selected according to the situation of the surgeon and the patient.
Objective To investigate the clinical efficacy and complications of flexible ureteroscopic lithotripsy(f-URS)and miniaturized percutaneous nephrolithotomy(m-PCN)in the treatment of 10-20 mm lower-calyx calculi in elderly patients.Methods A retrospective study was performed on 98 cases of patients more than 60 years old with lower-calyx calculi who were admitted from January 2015 to December 2017.The patients were divided into the f-URS group(n=48)and the m-PCN group(n=50)according to different surgical methods,and the operation time,occurrence of postoperative complications,length of stay and discharge stone removal rate of the patients in the two groups were compared.Results The operative time of patients in the f-URS group was longer than that of the m-PCN group,while the degree of postoperative hemoglobin decline was lower than that of the m-PCN group,and the postoperative hospitalization time was shorter than that of the m-PCN group,with statistically significant differences(P<0.05).There was no statistically significant difference in the incidence of postoperative complications such as high fever and bleeding between the two groups(P>0.05).The success rate of discharge lithotomy in the f-URS group and m-PCN group was 89.6%(43/48)and 92.0%(46/50),respectively.The success rate of discharge lithotomy was no statistically significant difference between the two groups(P>0.05).Conclusion F-URS and m-PCN have their own advantages in the treatment of lower-calyceal calculi of 10-20 mm kidney in elderly patients,and the specific operation method needs to be selected according to the situation of the surgeon and the patient.
引文
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[9] 王世先,杨水法,王飞,等.超微经皮肾镜与输尿管软镜治疗中等大小肾下盏结石的前瞻性对比研究[J].中华泌尿外科杂志,2018,39(3):209-213.
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[11] 张磊,夏亭,任祥斌,等.输尿管软镜碎石术与经皮肾镜碎石术治疗直径10～20 mm肾下盏结石效果的对比分析[J].泌尿外科杂志(电子版),2014,6(3):17-20.
[2] Wang W,Fan J,Huang G,et al.Prevalence of kidney stones in mainland China:a systematic review[J].Sci Rep,2017,7:41630.
[3] 那彦群,叶章群,孙颖浩,等.中国泌尿外科疾病诊断治疗指南[M].北京:人民卫生出版社,2014:100-101.
[4] 高小峰,张威,彭泳涵,等.同期双侧输尿管软镜钬激光碎石术安全性及疗效分析[J].第二军医大学学报,2013,34(12):1380-1383.
[5] Ozgor F,Yanaral F,Savun M,et al.Comparison of miniaturized percutaneous nephrolithotomy and flexible ureterorenoscopy for moderate size renal stones in elderly patients[J].Kaohsiung J Med Sci,2018,34(6):352-356.
[6] Burgher A,Beman M,Holtzman JL,et al.Progression of nephrolithiasis:long-term outcomes with observation of asymptomatic calculi[J].J Endourol,2004,18(6):534-539.
[7] Ng CF.The effect of age on outcomes in patients undergoing treatment for renal stones[J].Curr Opin Urol,2009,19(2):211-214.
[8] Akman T,Binbay M,Ugurlu M,et al.Outcomes of retrograde intrarenal surgery compared with percutaneous nephrolithotomy in elderly patients with moderate-size kidney stones:a matched-pair analysis[J].J Endourol,2012,26(6):625-629.
[9] 王世先,杨水法,王飞,等.超微经皮肾镜与输尿管软镜治疗中等大小肾下盏结石的前瞻性对比研究[J].中华泌尿外科杂志,2018,39(3):209-213.
[10] Lee JW,Park J,Lee SB,et al.Mini-percutaneous nephrolithotomy vs retrograde intrarenal surgery for renal stones larger than 10 mm:a prospective randomized controlled trial[J].Urology,2015,86(5):873-877.
[11] 张磊,夏亭,任祥斌,等.输尿管软镜碎石术与经皮肾镜碎石术治疗直径10～20 mm肾下盏结石效果的对比分析[J].泌尿外科杂志(电子版),2014,6(3):17-20.