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摘要: 目的 探索新型软性肾镜在经皮肾镜取石术(percutaneous nephrolithotomy，PCNL)中的应用效果。方法 回顾性分析2022年1月—2023年2月海军军医大学第一附属医院通过标准通道PCNL治疗的肾结石患者临床资料，依据术中是否使用新型软性肾镜将患者分为联合软性肾镜组和单用硬镜组；比较2组患者手术相关临床数据。结果 联合软性肾镜组52例，单用硬镜组42例，2组患者年龄[(55.9±11.3)岁vs (53.7±13.7)岁，P=0.407]、体重指数(BMI)[(24.7±3.3) kg/m2 vs (24.6±3.3) kg/m2，P=0.915]及结石最大径[(33.5±13.6) mm vs (39.0±17.0) mm，P=0.085]比较差异无统计学意义。联合软性肾镜组11例患者术中通过软性肾镜成功寻找到硬镜无法处理的残余结石并成功碎石取石。联合软性肾镜组结石清除率显著高于单用硬镜组的患者(84.6% vs 57.1%，P=0.003)且术后住院时间更短[(3.4±1.4) d vs (4.81±2.2) d，P < 0.001]。结论 超细、超短的新型电子软性肾镜可以有效检出单通道PCNL硬镜碎石后残留结石，提高结石清除率，缩短术后住院时间。Abstract: Objective To explore the effectiveness of a novel flexible nephroscope in percutaneous nephrolithotomy (PCNL).Methods From January 2022 to February 2023, a retrospective study was conducted on the clinical data of the patients with renal calculi who underwent PCNL with standard channel. Patients were divided into two groups according to whether the novel flexible electronic nephroscope was used during the operation: the combined flexible nephroscope group and the rigid nephroscope group. The clinical data of two groups were compared.Results There were 52 cases in the combined flexible nephroscope group and 42 cases in the rigid nephroscope group. Age ([55.9±11.3] years vs [53.7±13.7] years, P=0.407), BMI ([24.7±3.3] kg/m2vs [24.6±3.3] kg/m2, P=0.915) and maximum diameter of stone ([33.5±13.6] mm vs [39.0±17.0] mm, P=0.085) were not statistically significant between two groups. In 11 patients of the combined flexible nephroscope group, residual stones that could not be handled by the rigid nephroscope were successfully located and treated during surgery using the new flexible nephroscope, resulting in successful fragmentation and removal of the stones. The combined flexible nephroscope group had a significantly higher stone clearance rate than the rigid nephroscope group alone (84.6% vs 57.1%, P=0.003) and a shorter postoperative hospital stay ([3.4±1.4] d vs [4.81±2.2] d, P < 0.001).Conclusion The new ultra-fine and ultra-short electronic flexible nephroscope can effectively detect residual stones after single-channel rigid nephroscopy, improve the stone clearance rate and reduce postoperative hospital stay.
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Key words:
- renal calculi /
- percutaneous nephroscope /
- flexible nephroscope
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表 1 联合软性肾镜组与单用硬镜组基本资料比较
例，X±S 项目 联合软性肾镜组(52例) 单用硬镜组(42例) t χ2 P值 男/女 40/12 24/18 4.184 0.048 年龄/岁 55.9±11.3(31~81) 53.7±13.7(22~81) 0.833 0.407 BMI/(kg/m2) 24.7±3.3(16.5~36.7) 24.6±3.3(19.1~33.7) 0.107 0.915 结石最大径/mm 33.5±13.6(11.0~73.5) 39.0±17.0(13.3~79.1) -1.702 0.085 
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表 2 联合软性肾镜组与单用硬镜组手术资料比较
例(%)，X±S 项目 联合软性肾镜组(52例) 单用硬镜组(42例) t χ2 P值 手术时间/min 99.1±44.6(35~245) 111.2±41.4(35~210) -1.355 0.179 结石清除率 44(84.6) 24(57.1) 8.764 0.003 残留结石总直径/mm 13.6±6.5(5.1~24.6) 19.2±9.6(6.0~45.0) -1.864 0.074 术后1 d血红蛋白下降量/(g/L) 8.7±9.5(-6.0~38.0) 11.3±12.9(-8.0~59.0) -1.111 0.269 住院天数/d 3.4±1.4(1~8) 4.8±2.2(2~14) -3.771 < 0.001 术后并发症率 5(9.6) 9(21.4) 2.558 0.096
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