Comparison between super-mini percutaneous nephrolithotomy and digital flexible ureteroscopy for the management of 2.0-2.5 cm stones in upper and middle calices of kidney
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摘要: 目的：比较超微经皮肾镜取石术（SMP）与电子输尿管软镜碎石术（FURL）治疗肾中、上盏2.0~2.5 cm结石的疗效。方法：回顾性分析2017年3月~2018年12月收治的90例肾中、上盏2.0~2.5 cm结石患者的临床资料，其中SMP组44例，FURL组46例，比较两组年龄、结石大小、手术时间、术后血红蛋白下降值、住院天数、住院费用、术前肾积水及感染情况、术后并发症及清石率。结果：SMP组和FURL组年龄分别为（45.84±7.69）岁和（46.76±7.55）岁，结石大小分别为（2.23±0.12） cm和（2.19±0.11） cm，术后1个月清石率分别为95.45%（42/44）和89.13%（41/46），两组比较差异均无统计学意义（P>0.05）。SMP和FURL组手术时间分别为（58.83±12.83） min和（107.43±14.65） min，术后血红蛋白下降值分别为（10.07±3.62） g/L和（4.39±2.71） g/L，术后住院天数分别为（3.39±1.37） d和（2.70±0.99） d，住院费用分别为（19 041.50±1 855.76）元和（22 086.70±1 942.67）元，术后1 d清石率分别为90.91%（40/44）和73.91%（34/46），两组比较差异均有统计学意义（P<0.05）。SMP组术后血尿3例，FURL组术后出现发热3例，明显血尿1例，均经保守治疗治愈。结论：对于肾中、上盏2.0~2.5 cm结石，SMP与FURL均为理想的手术方式。SMP具有即时清石率高、手术时间短、住院费用低等优势，而FURL具有创伤小、住院时间短等优势。Abstract: Objective: To compare the therapeutic effect between super-mini percutaneous nephrolithotomy(SMP) and digital flexible ureteroscopy(FURL) in treating patients with 2.0-2.5 cm stones in upper and middle calices of kidney. Method: We retrospectively analysed the general clinical data of 90 cases who had renal calculi in upper and middle calices ranging from 2.0-2.5 cm treated by either SMP(44) or FURL(46) between March 2017 and December 2018. The age, stone size, operation time, hemoglobin decline, postoperative hospital stay, hospitalization expense, preoperative hydronephrosis and infection, stone-free rate and complications were compared between the 2 groups. Result: The mean age, stone size and the stone-free rate after 1 month of the SMP group and FURL group were(45.84±7.69) years and(46.76±7.55) years,(2.23±0.12) cm and(2.19±0.11) cm, 95.45%(42/44) and 89.13%(41/46). There was no significant difference between two groups(P>0.05). The operation time, hemoglobin decline, postoperative hospital stay, hospitalization expense and the stone-free rate after 1 day of the SMP group and FURL group were(58.83±12.83) min and(107.43±14.65) min,(10.07±3.62) g/L and(4.39±2.71) g/L,(3.39±1.37) d and(2.70±0.99) d,(19 041.50±1 855.76) yuan and(22 086.70±1 942.67) yuan, 90.91%(40/44) and 73.91%(34/46), which there was statistical difference between two groups(P<0.05). In SMP group, obvious postoperative haemorrhage appeared in 3 cases. In FURL group, postoperative fever occurred in 3 cases, and obvious postoperative haemorrhage appeared in 1 case. All these complications were cured by conservative treatment.Conclusion: For 2.0-2.5 cm renal calculi in upper and middle calices, both SMP and FURL are effective. SMP has the advantages of higher immediate stone-free rate, shorter operation time and less expense, while FURL is better in less operation trauma and shorter hospital stay.
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