经输尿管镜与经皮肾镜治疗肾结石的临床疗效比较

目的 比较经皮肾镜和经输尿管镜治疗直径≤3cm的肾结石的疗效。方法 分析我科诊治的243例肾结石（结石≤3cm）患者的治疗方法及疗效。120例采用输尿管镜钬激光碎石术（观察组），123例采用经皮肾镜钬激光碎石取石术(PCNL)术（对照组）。比较两组患者的手术时间，术后并发症，血红蛋白下降值，术后导尿管留置时间，住院费用等。结果 观察组结石直径为（2.4±0.9）cm，对照组则为（2.3±0.9）cm，两组比较差异无统计学意义（p>0.05）。观察组有80例患者使用了软镜，术后有5例出现发热，无大出血及肾输尿管损伤等严重并发症。对照组术后有4例出现发热，术中、术后明显出血3例，其中2例经保守治疗后痊愈，另1例经选择性肾动脉栓塞治疗治愈。观察组的结石大小，术后并发症与对照组比较差异无统计学意义（P>0.05）。观察组导尿管留置时间、住院费用、血红蛋白下降值（5.0±2.4)d 、(13477.2±01754.3)、（ 0.25±0．1)g/L，均低于对照组的（7.0±3.7）d、 (25453.1±1763.5)、（15.6±7.1)g/L，手术时间上观察组为（105.2±38.2），高于对照组（95.5±18.3）两组比较差异有统计学意义(P<0.05)。 结论 输尿管镜下碎石术对于≤3cm的肾结石的治疗效果与PCNL相近，同时还具有创伤小、住院天数少、治疗费用低及并发症发生率低的优势。

Comparison of the clinical efficacy of percutaneous nephrolithotomy and ureteroscopy for the treatment of renal calculi

Objective To compare the therapeutic effect of percutaneous nephrolithotripsy(PCNL) and transureteroscopic in the treatment of patients whose diameter of renal calculi was ≤3 cm．Methods Analysis the treatment methods and curative effect of 243 cases of patients with kidney stones (diameter≤3cm) in our department from March 2011 to October 2012. One hundred twenty cases underwent the ureteroscopy Holmium laser lithotripsy (observation group) and 123 cases underwent percutaneous nephrolithotomy with holmium laser lithotripsy (PCNL) (control group). Operative time, postoperative complications, decreased hemoglobin values, postoperative indwelling catheter time and hospital expenses were compared in this two groups.Results The diameter of stone in observation group is (2.4 ± 0.9) cm, the control group was（2.3±0.9）cm. The difference of the two groups was not statistically significant (P＞0.05).There were 80 patients operated with the soft lenses in the observation group and five cases suffered fever. No serious complications such as bleeding and renal ureteral injury were observed. In the control group, there were four cases with fever, three cases bleeding obviously in and after operation, including two cases recovered after conservative treatment. Another one case recovered by selective renal artery embolization. In the observation group, the differences of the stone size, postoperative complications were not statistically significant  when compared with control group (P> 0.05). The postoperative indwelling catheter time（5.0±2.4)d , hospital expenses(13477.2±1754.3) and decreased hemoglobin values（0.25±0.1)g/L in the observation group were respectively lower than the control group (7.0 ± 3.7) d, (25453.1 ± 1763.5), (15.6 ± 7.1) g/L. Observation group on operation time was (105.2 + 38.2) higher than the control group (95.5 + 18.3).The differences was statistically significant (P <0.05). Conclusion The treatment effect of lithotripsy under ureteroscope for the patients with kidney stones (diameter≤3cm) is similar with PCNL. Meanwhile, lithotripsy under ureteroscope takes the advantage of less trauma, fewer hospital days, low treatment costs and low incidence of complications.