经皮肾镜与输尿管软镜治疗肾下盏小鹿角形结石的比较

目的比较经皮肾镜（PCNL）与输尿管软镜（FURS）治疗肾下盏小鹿角形结石的安全性及有效性。 方法回顾性纳入并分析我院2017年4月至2019年4月43例肾下盏小鹿角形结石，其中PCNL治疗20例（PCNL组），FURS治疗23例（FURS组），比较两组手术时间、结石清除率、手术并发症和术后住院天数等。 结果43例均顺利完成手术，PCNL组的手术时间、术后住院天数均显著长于FURS组（P<0.05）；术后1~4 d PCNL组结石清除率85.0%，显著高于FURS组52.2%，术后4周及术后半年两组结石清除率差异无统计学意义（P>0.05），但FURS组的二次干预率更高（P<0.05）；两组在术后发热、出血及石街形成等方面差异无统计学意义（P>0.05），但PCNL组的血红蛋白丢失量及术后止痛药使用率更高（P<0.05）。 结论PCNL与FURS在治疗肾下盏小鹿角形结石均安全、有效，两者远期疗效相当，但FURS比PCNL创伤更小，术后恢复更快，值得临床推广。

Comparison of percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of lower pole minor staghorn calculi

ObjectiveTo compare the safety and efficacy of percutaneous nephrolithotomy(PCNL) and flexible ureteroscopy(FURS) in treatment of lower pole minor staghorn calculi. MethodsFrom April 2017 to April 2019, 43 patients having lower pole minor staghorn calculi were treated with PCNL or FURS in our hospital. The patients were all retrospectively investigated and classified as PCNL group or FURS group. Of them, 20 patients received PCNL and 23 underwent FURS, respectively. The two groups were compared and analyzed statistically in terms of operation time, stone-free rate, surgical-related complications rate and postoperative hospital stay. ResultsSuccessful surgery had been done in all the patients. Operation time and postoperative hospital stay of the PCNL group were significantly longer than that of the FURS group (P<0.05). In PCNL group, initial stone-free rate(SFR) in 4 days after surgeries achieved 85.0%, which was significantly higher than that of 52.2% in FURS group (P<0.05). However, there was no significant difference between the two groups in terms of overall SFR in 4 weeks and 6 months after surgeries, respectively (P>0.05). Nevertheless, the need for further intervention(staged FURS surgery or ESWL) in the FURS group was significantly more than that in the PCNL group (P<0.05). Complication rate between the two groups was similar in terms of postoperative fever, bleeding and steinstrasse (P>0.05), but the PCNL group suffered more loss of hemoglobin and postoperative pain (P<0.05). ConclusionsBoth PCNL and FURS are safe and feasible for patients with minor renal staghorn calculi in the lower pole. Compared to PCNL, FURS deserves its priority to deal with lower pole minor staghorn calculi for its less invasive and faster postoperative recovery.