微通道經(jīng)皮腎鏡碎石與輸尿管軟鏡碎石治療孤立腎腎下盞2～3,cm結(jié)石的比較

　　[摘要] 目的 比較微通道經(jīng)皮腎鏡取石術(shù)（MPCNL）和輸尿管軟鏡碎石術(shù)（FURL）治療孤立腎腎下盞2～3cm結(jié)石的效果。 方法 回顧性分析2013年4月～2016年2月深圳市寶安區(qū)中心醫(yī)院治療的孤立腎結(jié)石96例臨床資料，根據(jù)治療方法的不同分為MPCNL組（52例）和FURL組（44例），并分析比較兩組的結(jié)石清除率、手術(shù)時(shí)間、術(shù)中出血量、住院時(shí)間、術(shù)后24 h血紅蛋白下降值和術(shù)后24 h血清肌酐升高值、手術(shù)并發(fā)癥、結(jié)石成分。 結(jié)果 MPCNL組一期結(jié)石清除率高于FURL組（P < 0.05），但兩組總結(jié)石清除率比較，差異無統(tǒng)計(jì)學(xué)意義（P > 0.05）；MPCNL組手術(shù)時(shí)間短于FURL組（P < 0.01），但術(shù)中出血量多于FURL組（P < 0.01），住院時(shí)間長(zhǎng)于FURL組（P < 0.01）；MPCNL組術(shù)后24 h血紅蛋白下降值高于FURL組（P < 0.01），兩組術(shù)后24 h血清肌酐升高值比較，差異無統(tǒng)計(jì)學(xué)意義（P > 0.05）；MPCNL組與FURL組并發(fā)癥發(fā)生率比較，差異有統(tǒng)計(jì)學(xué)意義（P < 0.05）；兩組結(jié)石成分比較，差異無統(tǒng)計(jì)學(xué)意義（P > 0.05）。 結(jié)論 治療2～3 cm孤立腎腎下盞結(jié)石，MPCNL雖然一期結(jié)石清除率高于FURL，但FURL出血更少，住院時(shí)間更短，在一定程度上可以作為一種替代的治療方式。
　　[關(guān)鍵詞] 孤立腎；腎結(jié)石；經(jīng)皮腎鏡碎石取石術(shù)；輸尿管軟鏡碎石術(shù)
　　[中圖分類號(hào)] R692.4 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 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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