斜仰卧-截石位下微小通道经皮肾镜取石术与输尿管软镜碎石术治疗最大径1～2cm肾下盏结石的疗效比较

Comparison of micro-percutaneous nephrolithotomy in oblique supine-lithotomy position and flexible ureteroscopic lithotripsy in the treatment of 1-2 cm lower-pole stones

摘要

目的 通过与输尿管软镜碎石术（FURL）比较，探讨斜仰卧-截石位下微小通道经皮肾镜取石术（microPCNL）治疗最大径1～2 cm肾下盏结石（LPSs）的临床疗效及安全性，寻找治疗肾下盏结石的有效手术方法。方法 回顾性分析2023年1-12月武汉大学人民医院泌尿外科收治的56例直径1～2 cm的孤立性LPSs患者的临床资料，根据治疗方式分为FURL组（截石位下FURL，n=31）和microPCNL组（斜仰卧-截石位下microPCNL，n=25），比较两组患者的一般资料及围手术期资料。结果 两组手术均顺利完成，microPCNL组较FURL组患者手术时间更短[（46.5±10.1）min vs.（73.5±18.9）min，P＜0.001]，结石清除率（SFRs）更高（92.0% vs. 71.0%，P=0.026），而两组患者在平均血红蛋白下降水平、血肌酐变化水平、术后住院时间及术后发热等方面的差异无统计学意义（P＞0.05）。结论 斜仰卧-截石位下microPCNL用于治疗1～2 cm的LPSs安全有效，且SFRs高于FURL。

Abstract

Objective To evaluate the clinical efficacy and safety of micro-percutaneous nephrolithotomy (microPCNL) using Needle-perc in the oblique supine-lithotomy position for treating 1-2 cm lower-pole stones (LPSs), by comparing it with flexible ureteroscopic lithotripsy (FURL), so as to identify an effective surgical method for LPSs. Methods We retrospectively analyzed the clinical data of 56 patients with isolated LPSs of 1-2 cm treated in our hospital during Jan. and Dec. 2023. Patients were divided into two groups based on the treatment method: FURL (n=31) and microPCNL (n=25). General information and perioperative data were compared between the two groups. Results All operations were successfully completed. The operation time was shorter in the microPCNL group than in the FURL group [(46.5±10.1) min vs. (73.5±18.9) min, P<0.001]. Stone-free rate (SFR) was 92.0% in the microPCNL group and 71.0% in the FURL group (P=0.026). There were no significant differences in the average fall of hemoglobin level, serum creatinine change level, hospitalization time and postoperative fever between the two groups. Conclusion MicroPCNL in oblique supine-lithotomy position is a safe and effective treatment for 1-2 cm LPSs, with a higher SFR compared to FURL.

关键词

微小通道经皮肾镜取石术 / 输尿管软镜碎石术 / 针状肾镜 / 下盏结石 / 斜仰卧-截石位

Key words

micro-percutaneous nephrolithotomy / flexible ureteroscopic lithotripsy / Needle-perc / lower-pole stones / oblique supine-lithotomy position

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