微通道经皮肾镜碎石与输尿管软镜碎石治疗孤立肾肾下盏2～3,cm结石的比较

　　[摘要] 目的 比較微通道经皮肾镜取石术（MPCNL）和输尿管软镜碎石术（FURL）治疗孤立肾肾下盏2～3cm结石的效果。 方法 回顾性分析2013年4月～2016年2月深圳市宝安区中心医院治疗的孤立肾结石96例临床资料，根据治疗方法的不同分为MPCNL组（52例）和FURL组（44例），并分析比较两组的结石清除率、手术时间、术中出血量、住院时间、术后24 h血红蛋白下降值和术后24 h血清肌酐升高值、手术并发症、结石成分。 结果 MPCNL组一期结石清除率高于FURL组（P < 0.05），但两组总结石清除率比较，差异无统计学意义（P > 0.05）；MPCNL组手术时间短于FURL组（P < 0.01），但术中出血量多于FURL组（P < 0.01），住院时间长于FURL组（P < 0.01）；MPCNL组术后24 h血红蛋白下降值高于FURL组（P < 0.01），两组术后24 h血清肌酐升高值比较，差异无统计学意义（P > 0.05）；MPCNL组与FURL组并发症发生率比较，差异有统计学意义（P < 0.05）；两组结石成分比较，差异无统计学意义（P > 0.05）。 结论 治疗2～3 cm孤立肾肾下盏结石，MPCNL虽然一期结石清除率高于FURL，但FURL出血更少，住院时间更短，在一定程度上可以作为一种替代的治疗方式。
　　[关键词] 孤立肾；肾结石；经皮肾镜碎石取石术；输尿管软镜碎石术
　　[中图分类号] R692.4 [文献标识码] A [文章编号] 1673-7210（2018）02（c）-0058-05
　　Comparison of the treatment of minimally invasive percutaneous nephro？鄄lithotomy and flexible ureteroscope lithotripsy for solitary kidney subrenal calyx calculus 2-3 cm
　　ZHANG Yu1，2 JIANG Youtao3 LI Jiuzhi3 CHEN Lezhong1 WU Yue2
　　1.Department of Urology， Baoan Central Hospital of Shenzhen， Guangdong Province， Shenzhen 518102， China； 2.Department of Urology， the Sixth Affiliated Hospital of XinJiang Medical University， Xinjiang Uygur Autonomous Region， Urumqi 830000， China； 3. People′s Hospital of XinJiang Uygur Autonomous Region， Urumqi， Xinjiang Uygur Autonomous Region， Urumqi 830001， China
　　[Abstract] Objective To compare the effects of minimally invasive percutaneous nephrolithotomy （MPCNL） and flexible ureteroscope lithotripsy （FURL） for the treatment of solitary kidney subrenal calyx calculus 2-3 cm. Methods The clinical data of 96 cases of isolated kidney stone and treated in Baoan Central Hospital of Shenzhen from April 2013 to February 2017 were analyzed retrospectively. According to the different treatment methods， they were divided into MPCNL group （52 cases） and FURL group （44 cases）， and the stone clearance rate， operation time， intraoperative bleeding， length of hospital stay， 24 hours postoperatively hemoglobin drop value and 24 hours postoperatively serum creatinine elevation value， surgical complications， and calculi composition were compared between the two groups. Results The phase 1 calculi clearance rate of MPCNL group was higher than that of FURL group （P < 0.05）， but the total stone clearance rate of both groups were compared， the difference was not statistically significant （P > 0.05）. The operation time of MPCNL group was shorter than that of FURL group （P < 0.01）， but the intraoperative bleeding of MPCNL group higher than that of FURL group （P < 0.01）， the length of hospital stay of MPCNL group was longer than that of FURL group （P < 0.01）. The 24 hours postoperatively hemoglobin drop value of MPCNL group was higher than that of FURL group （P < 0.01）， the 24 hours postoperativedy serum creatinine elevation value of both groups were compared， the difference was not statistically significant （P > 0.05）. The surgical complications of MPCNL group and FURL group were compared， the difference was not statistically significant （P < 0.05）. The calculi composition of both groups were compared， the difference was not statistically significant （P > 0.05）. Conclusion In the treatment of solitary kidney subrenal calyx calculus 2-3 cm， although the phase 1 calculi clearance rate of MPCNL is higher than FURL， FURL is less bleeding， and the length of hospital stay is shorter， which could be used as an alternative treatment to some extent.

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