Comparison of efficacy and safety between UMP and RIRS in the treatment of 1-2 cm kidney stones
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摘要: 目的 对比超细经皮肾镜取石术(ultra-mini percutaneous nephrolithotripsy，UMP)与逆行输尿管软镜碎石术(retrograde intrarenal surgery，RIRS)治疗1~2 cm肾结石的疗效、安全性。方法 前瞻性分析2020年1月—2022年12月宁波市杭州湾医院及上海交通大学医学院附属仁济医院收治的60例直径为1~2 cm的肾结石患者，随机分入UMP组(30例)、RIRS组(30例)。比较2组手术指标及术后情况。结果 RIRS组手术时间较UMP组长，差异有统计学意义(P < 0.05)；UMP组住院费用较RIRS组少，差异有统计学意义(P < 0.05)。2组术后1个月及3个月的结石清除率(stone free rate，SFR)差异无统计学意义(P>0.05)。2组碎石时间、住院天数差异无统计学意义(P>0.05)。2组术后的血白细胞(white blood cell，WBC)、C反应蛋白(C-reactive protein，CRP)均较术前上升，差异有统计学意义(P < 0.05)，但2组的升高程度间差异无统计学意义(P>0.05)。2组术后的血红蛋白(hemoglobin，Hb)值均较术前下降，差异有统计学意义(P < 0.05)，2组的下降程度间差异无统计学意义(P>0.05)，但UMP组出现1例严重血尿的患者，术后Hb较术前下降62 g/L，经数字减影血管造影(digital subtraction angiography，DSA)介入治疗1次后好转。2组术后的降钙素原(procalcitonin，PCT)及肌酐水平较术前无明显变化(P>0.05)。2组术后并发症的发生率差异无统计学意义(P>0.05)。结论 对于1~2 cm的肾结石患者，UMP及RIRS均是有效的手术治疗方法，两者术后SFR、并发症发生率、住院时间相当。UMP手术时间短、住院费用低，但存在出血的风险；而RIRS手术时间长、住院费用高，但出血风险更低。
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关键词:
- 超细经皮肾镜取石术 /
- 逆行输尿管软镜碎石术 /
- 肾结石 /
- 疗效 /
- 安全性
Abstract: Objective To compare the efficacy and safety between ultra-mini percutaneous nephrolithotripsy(UMP) and retrograde intrarenal surgery(RIRS) in the treatment of 1-2 cm renal calculus.Methods A prospective analysis was performed on 60 patients with renal calculus with a diameter of 1-2 cm admitted to our hospital and Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to December 2022, and they were randomly divided into UMP group (n=30) and RIRS group (n=30). The operative indexes and postoperative conditions of the two groups were compared.Results The operation time in RIRS group was longer than that in UMP group, and the difference was statistically significant (P < 0.05). The hospitalization cost in UMP group was less than that in RIRS group, and the difference was statistically significant (P < 0.05). There was no significant difference in stone removal rate 1 month or 3 months after surgery between the two groups (P>0.05). There was no significant difference in lithotripsy time or hospitalization days between the two groups (P>0.05).The blood WBC and CRP of the two groups increased after surgery, and the difference was statistically significant (P < 0.05). However, the degree of increase between the two groups has no significant difference (P>0.05). The hemoglobin value of the two groups decreased after surgery, and the difference was statistically significant (P < 0.05). Similarly, the degree of decline has no significant difference between the two groups (P>0.05). However, there was one case of severe hematuria in the UMP group, and the hemoglobin decreased by 62 g/L after surgery compared with that before surgery. The patient was cured by digital subtraction angiography(DSA)interventional treatment.The PCT and creatinine levels of the two groups after operation had no significant changes compared with those before operation. There was no significant difference in the postoperative complication rate between the two groups (P>0.05).Conclusion Both UMP and RIRS are effective surgical treatments for patients with 1-2 cm kidney stones for similar postoperative SFR, complication rate and hospital stay. UMP has short operation time and low hospitalization cost, but the risk of bleeding exists.RIRS has long operation time and high hospitalization cost, but the risk of bleeding is lower. -
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表 1 2组患者基线资料比较
例(%)，X±S 项目 UMP组(30例) RIRS组(30例) P值 年龄/岁 51.93±11.91 47.03±11.75 0.114 性别 1.000 男 21(70.0) 21(70.0) 女 9(30.0) 9(30.0) BMI/(kg/m2) 24.77±3.02 25.43±7.40 0.652 结石直径/mm 15.95±2.77 15.43±3.05 0.488 结石CT值/HU 1 238.10±230.66 1 255.16±250.65 0.785 结石位置 0.284 左侧 21(70.0) 17(56.7) 右侧 9(30.0) 13(43.3) 尿白细胞计数/(个/HP) 39.25±63.91 32.84±37.77 0.638 血WBC/(×109/L) 6.63±1.45 6.51±1.48 0.760 CRP/(mg/dL) 1.60±2.07 2.35±5.07 0.456 PCT/(ng/mL) 0.03±0.02 0.03±0.02 0.467 肌酐/(μmol/L) 72.62±17.53 72.77±13.88 0.971 Hb/(g/L) 145.00±16.90 147.07±14.30 0.611 注：WBC：白细胞计数；CRP：C反应蛋白；PCT：降钙素原；Hb：血红蛋白。 
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表 2 2组住院天数、手术时间、住院费用比较
X±S 指标 UMP组 RIRS组 P值 住院天数/d 2.87±2.93 1.73±1.05 0.051 手术时间/min 30.70±15.97 44.47±23.96 0.011 住院费用/元 14 788.19±3 949.63 18 431.71±2 616.09 0.009
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表 3 2组术前及术后血WBC、CRP、PCT、肌酐、Hb变化
X±S 组别 术前 术后 P值 RIRS组 血WBC/(×109/L) 6.51±1.49 9.93±2.67 0.001 CRP/(mg/dL) 2.34±5.07 4.93±9.47 0.018 PCT/(ng/mL) 0.30±0.02 0.45±0.10 0.410 肌酐/(μmol/L) 72.77±13.88 69.48±14.47 0.054 Hb/(g/L) 147.07±14.30 133.97±12.65 0.001 UMP组 血WBC/(×109/L) 6.63±1.45 10.97±2.37 0.001 CRP/(mg/dL) 1.60±2.07 5.35±7.30 0.012 PCT/(ng/mL) 0.03±0.02 0.03±0.03 0.416 肌酐/(μmol/L) 72.62±17.53 74.91±13.70 0.323 Hb/(g/L) 145.00±16.90 128.63±15.69 0.001
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表 4 2组术前及术后血WBC、CRP、PCT、肌酐、Hb变化值比较
X±S 指标 UMP组 RIRS组 P值 血WBC变化值/(×109/L) 4.34±2.17 3.42±2.28 0.117 CRP变化值/(mg/dL) 3.75±7.70 2.58±5.63 0.504 PCT变化值/(ng/mL) 0.01±0.03 0.02±0.10 0.556 肌酐变化值/(μmol/L) 2.29±12.49 -3.29±8.98 0.052 Hb变化值/(g/L) -16.37±10.95 -13.10±9.05 0.213
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表 5 2组术后SFR、并发症发生率比较
项目 UMP组 RIRS组 P值 术后并发症发生率/% 0.554 发热 3.3 3.3 出血 3.3 0 SFR/% 0.998 术后1个月SFR 90.0 93.3 术后3个月SFR 100.0 96.7
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