Efficacy analysis of flexible ureteroscopy with a tip-bendable suction ureteral access sheath for treatment of 2-3 cm lower-pole renal stones
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摘要: 目的 探讨输尿管软镜(flexible ureteroscopy，f-URS)联合头端可弯负压吸引鞘(tip-bendable suction ureteral access sheath，S-UAS)治疗肾下盏2~3 cm结石的安全性与有效性。方法 回顾性分析2022年12月—2024年12月天津医科大学第二医院收治的87例2~3 cm单纯肾下盏结石患者的临床资料，其中38例接受f-URS联合S-UAS治疗(fURS-SUAS组)，49例接受经皮肾镜取石术(percutaneous nephrolithotomy，PCNL)治疗(PCNL组)。收集并比较2组患者的基本临床资料(年龄、性别、体重指数、结石直径、结石CT值、肾积水程度、肾功能与术前感染情况)、手术相关数据(手术时间、住院天数、住院费用)、术后并发症(术后发热、血红蛋白下降值、疼痛视觉模拟评分、Clavien分级)、术后3 d内及术后1个月清石率。结果 2组患者基本信息、手术时间、清石率、术后并发症等比较均差异无统计学意义(P>0.05)；fURS-SUAS组的患者住院天数为(4.24±2.47) d，少于PCNL组的(6.29±2.61) d，2组比较差异有统计学意义(P < 0.01)；fURS-SUAS组住院开支为(25 816.65±5 698.00)元，低于PCNL组的(35 488.92±4 727.78)元，2组比较差异有统计学意义(P < 0.01)。结论 治疗2~3 cm的肾下盏结石，f-URS联合S-UAS具有与PCNL相当的清石率，且显著缩短了患者住院时间、降低了手术费用，同时未增加术后发热、出血及疼痛等并发症的发生率。Abstract: Objective To investigate the safety and efficacy of flexible ureteroscopy(f-URS) combined with a tip-bendable suction ureteral access sheath(S-UAS) for the treatment of 2-3 cm lower-pole renal stones.Methods A retrospective analysis was conducted on 87 patients with 2-3 cm lower-pole renal stones admitted to the Second Hospital of Tianjin Medical University between December 2022 and December 2024. Among these patients, 38 underwent f-URS combined with S-UAS(fURS-SUAS group), and 49 underwent percutaneous nephrolithotomy(PCNL)(PCNL group). Baseline clinical data(age, sex, BMI, stone diameter, CT value, level of hydronephrosis, renal function status, and preoperative infection), surgical parameters(operative time, length of hospital stay, hospitalization costs), postoperative complications(postoperative fever, hemoglobin drop, VAS pain scores, Clavien classification), immediate stone free rate(SFR) and 1-month postoperative SFR were collected.Results There were no statistically significant differences between the two groups in terms of basic patient information, operative time, SFR, or postoperative complications(P>0.05). The length of hospital stay in the fURS-SUAS group([4.24±2.47] days) was shorter than that in the PCNL group([6.29±2.61] days). Meanwhile, the hospitalization cost in the fURS-SUAS group([25 816.65±5 698.00] RMB) was lower than that in the PCNL group([35 488.92±4 727.78] RMB), and both differences were statistically significant(P < 0.05).Conclusion For the treatment of 2-3 cm lower pole kidney stones, fURS-SUAS achieved a SFR comparable to that of PCNL, while significantly reducing hospital stay and cost, without increasing the incidence of postoperative fever, bleeding, or pain.
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表 1 2组患者一般资料比较
例(%)，X±S 项目 fURS-SUAS组(38例) PCNL组(49例) t/χ2 P值 年龄/岁 55.89±12.30 55.37±11.50 0.206 0.837 性别 0.092 0.938 男 26(68.42) 35(71.43) 女 12(31.58) 14(28.57) 体重指数/(kg/m2) 27.27±4.01 25.85±3.82 1.689 0.095 术前白细胞/(×109/L) 6.41±1.61 7.05±2.14 -1.509 0.135 术前尿路感染 20(52.63) 23(46.94) 0.277 0.598 肾功能不全 4(10.53) 7(14.29) 0.274 0.601 肾积水程度 0.844 0.643 无 25(65.79) 30(61.22) 轻度 13(34.21) 18(36.73) 中度/重度 0(0) 1(2.05) 患侧 1.755 0.083 左 22(57.89) 37(75.51) 右 16(42.11) 12(24.49) 结石最大长径/cm 2.52±0.38 2.59±0.34 -0.973 0.333 CT值/HU 944.26±350.00 1 131.48±355.28 -1.665 0.100 
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表 2 2组患者观察指标比较
例(%)，X±S 指标 fURS-SUAS组(38例) PCNL组(49例) t/ χ2 P值 SFR 术后即刻 29(76.32) 39(79.59) 0.135 0.714 术后1个月 35(92.11) 43(87.76) 0.437 0.509 手术时间/min 54.39±27.34 47.86±22.29 1.229 0.223 术中输血 0(0) 0(0) — 术后发热(≥38.5℃) 2(5.26) 4(8.16) 0.280 0.602 脓毒症 0(0) 0(0) — 术后WBC/(×109/L) 11.37±2.69 10.67±3.45 0.407 0.685 WBC变化量/(×109/L) 5.06±2.75 3.94±4.06 1.473 0.144 NE%/% 83.60±6.81 80.75±9.41 1.570 0.120 血红蛋白下降量/(g/L) 0.50±5.47 2.02±9.28 0.953 0.373 VAS评分/分 术后 3.55±0.83 3.37±1.11 0.858 0.393 术后2周 1.58±0.98 1.59±0.91 -0.063 0.950 Clavien分级 0.595 0.441 1级 36(94.74) 46(93.88) 2级 2(5.26) 3(6.12) 3级 0(0) 0(0) 4级 0(0) 0(0) 5级 0(0) 0(0) 住院天数/d 4.24±2.47 6.29±2.61 -3.717 < 0.001 住院费用/元 25 816.65±5 698.00 35 488.92±4 727.78 -8.651 < 0.001
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