[1]徐磊* 陈弋生 陶凌松 刘应清 程龙.单通道半无管化微创经皮肾镜与输尿管软镜治疗高CT值顽固性肾结石的比较[J].中国微创外科杂志,2020,01(8):708-712.
　Xu Lei,Chen Yisheng,Tao Lingsong,et al.Comparison Between Single Tract Semitubeless Miniinvasive Percutaneous Nephrolithotomy and Flexible Ureteroscopic Lithotripsy in the Treatment of Refractory Renal Stones With High CT Value[J].Chinese Journal of Minimally Invasive Surgery,2020,01(8):708-712.
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单通道半无管化微创经皮肾镜与输尿管软镜治疗高CT值顽固性肾结石的比较()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2020年8期
页码:
708-712
栏目:
临床研究
出版日期:
2020-08-25

文章信息/Info

Title:
Comparison Between Single Tract Semitubeless Miniinvasive Percutaneous Nephrolithotomy and Flexible Ureteroscopic Lithotripsy in the Treatment of Refractory Renal Stones With High CT Value
作者:
徐磊* 陈弋生 陶凌松 刘应清 程龙
（安徽省芜湖市第二人民医院泌尿外科，芜湖241000）
Author(s):
Xu Lei;  Chen Yisheng;  Tao Lingsong;  et al.
Department of Urology, Second People’s Hospital of Wuhu, Wuhu 241000, China
关键词:
肾结石; 微创经皮肾镜取石术; 输尿管软镜碎石术; 单通道; 无管化
Keywords:
Kidney stone; Miniinvasive percutaneous nephrolithotomy; Flexible ureteroscopic lithotripsy; Single tract; Tubeless
文献标志码:
A
摘要:
目的对比单通道半无管化微创经皮肾镜碎石（miniinvasive percutaneous nephrolithotomy，MPCNL）和输尿管软镜碎石（flexible ureteroscopic lithotripsy，FURL）治疗高CT值顽固性肾结石的疗效。方法对2018年12月~2019年12月CT值>800 HU的46例顽固性肾结石行单通道半无管化（不留置肾造瘘管）MPCNL（24例）或FURL（22例），比较2组清石效果和并发症。结果FURL组2例导入鞘无法进入输尿管上段，1例导入鞘无法进入输尿管内而行裸镜碎石。MPCNL组手术时间长［（88.9±405）min vs. (47.8±21.5)min，t=4.240，P=0.000］，术后住院时间长［(4.5±1.3)d vs. (2.6±0.9)d，t=5.421，P=0000］，但出院前结石清除率（stone free rate，SFR）高［79.2%(19/24) vs. 50.0%(11/22), χ2=4.305, P=0038］，2组术后血红蛋白下降值、并发症发生率和拨除双J管后SFR差异无显著性(P>0.05)。MPCNL组术后发热3例，迟发性出血1例，胸腔积液1例；FURL组术后发热4例，持续性血尿1例。结论单通道半无管化MPCNL和FURL均是处理高CT值顽固性肾结石有效的方法，具有相同的安全性，单通道半无管化MPCNL术后即时清石率更高。
Abstract:
ObjectiveTo compare the clinical efficiency of single tract semitubeless miniinvasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopic lithotripsy (FURL) in the treatment of refractory renal stones with high CT value.MethodsFrom December 2018 to December 2019, 46 cases of refractory renal calculi, with CT value more than 800 HU, were treated with single tract semitubeless (without nephrostomy tube) MPCNL (24 cases) or FURL (22 cases). The stonefree effect and complications of the two groups were compared.ResultsIn the FURL group, there were 2 cases of ureteral access sheaths unable to enter the upper ureter and 1 case unable to enter the ureter, all of which underwent naked flexible ureteroscopic lithotripsy without ureteral access sheath. In the MPCNL group, the operation time ［(88.9±40.5) min vs. (47.8±21.5) min, t=4.240, P=0.000］ and postoperative hospital stay ［(4.5±1.3) d vs. (2.6±0.9) d, t=5.421, P=0.000］ were longer, but stone free rate (SFR) before discharge was higher ［79.2% (19/24) vs. 50.0% (11/22), χ2=4.305, P=0.038］. There was no significant difference between the two groups in hemoglobin reduction, surgical complications and SFR after removing the double J stent (P>0.05). There were 3 cases of postoperative fever, 1 case of delayed hemorrhage and 1 case of pleural effusion in the MPCNL group, while 4 cases of postoperative fever and 1 case of persistent hematuria in the FURL group.ConclusionsBoth single tract semitubeless MPCNL and FURL are effective methods for the treatment of refractory renal calculi with high CT value. Single tract semitubeless MPCNL has the same safety as FURL and higher immediate stone free rate after operation than FURL.

参考文献/References:

[1]Resorlu B,Unsal A,Ziypak T,et al.Comparison of retrograde intrarenal surgery,shock wave lithotripsy,and percutaneous nephrolithotomy for treatment of mediumsized radiolucent renal stones.World J Urol,2013,31(6):1581-1586.
[2]Nakasato T,Morita J,Ogawa Y.Evaluation of Hounsfield Units as a predictive factor for the outcome of extracorporeal shock wave lithotripsy and stone composition.Urolithiasis,2015,43(1):69-75.
[3]Elassmy A,Elnahas AR,Aboelghar ME,et al.Predictors of success after extracorporeal shock wave lithotripsy (ESWL) for renal calculi between 20-30 mm: a multivariate analysis model.Sci World J,2006,6:2388-2395.
[4]梁丽莉,李炳魁.上尿路结石ESWL治疗后复发原因探讨.中华泌尿外科杂志,1993,14(6):460-462.
[5]Sumino Y,Mimata H,Tasaki Y,et al.Predictors of lower pole renal stone clearance after extracorporeal shock wave lithotripsy.J Urol,2002,168(4 Pt 1):1344-1347.
[6]郭应禄，周利群，译.坎贝尔泌尿外科学.北京：北京大学医学出版社，2009.1468-1469.
[7]Saw KC，Mcateer JA，Fineberg NS，et al.Calcium stone fragility is pedicted by helical CT attenuation values．J Endourol，2000,14(6):471-474.
[8]Gyan P，James B，Georgia P，et al．Predicting ESWL stonefree rates using body mass index and housfield units．J Urol，2004，171(4)：498-499.
[9]Gupta NP，Ansari MS，Kesarvani P，et al．Role of computed tomography with no contrast medium enhancement in predicting the outcome of extracorporeal shock wave lithotripsy for urinary calculi．BJU Int，2015，95(9)：1285-1288.
[10]陈立杰，吕学锋，郭强，等.微通道经皮肾镜取石术与标准通道经皮肾镜取石术治疗上尿路结石的荟萃分析.现代泌尿外科杂志,2019,24(10):837-842，846.
[11]Xun Y,Wang Q,Hu H,et al.Tubeless versus standard percutaneous nephrolithotomy: an update metaanalysis.BMC Urol,2017,17(1):102.
[12]Tirtayasa PMW,Yuri P,Birowo P,et al.Safety of tubeless or totally tubeless drainage and nephrostomy tube as a drainage following percutaneous nephrolithotomy:a comprehensive review.Asian J Surg,2017,40(6):419-423.
[13]刘百川，张福霖，钟瑞伦，等.MPCNL与FURL治疗肾实质厚度>2.5 cm的2～3 cm肾结石的疗效对比.临床泌尿外科杂志,2018,33(7):537-541.
[14]郑昌建，钟强，赵春雷，等.微创与标准经皮肾镜取石术比较的荟萃分析.重庆医科大学学报,2013,38(2):205-209.
[15]Soares RMO,Zhu A,Talati VM,et al.Upper pole access for prone percutaneous nephrolithotomy:advantage or risk?Urology,2019,134:66-71.
[16]韦巍，黄剑华，钟羽翔，等.2～3 cm肾结石的CT值对输尿管软镜碎石效果的预估价值.中华腔镜泌尿外科杂志（电子版）,2019,13(2):95-98.
[17]王亚园，许长宝，褚校涵，等.超微经皮肾镜与输尿管软镜治疗直径2～3 cm高CT值肾结石疗效对比.实用医学杂志,2018,34(13):2181-2184.
[18]Resorlu B,Oguz U,Resorlu EB,et al.The impact of pelvicaliceal anatomy on the success of retrograde intrarenal surgery in patients with lower polerenal stones.Urology,2012,79(1):61-66.
[19]杨嗣星，宋超，刘凌琪，等.肾盂肾下盏漏斗角小于30°患者软镜下钬激光碎石术的初步经验.中华泌尿外科杂志,2016,37(6):423-426.
[20]谭军，杨国胜.肾下盏解剖结构在输尿管软镜治疗肾下盏结石中的研究进展.现代泌尿外科杂志,2019,24(4):320-324.
[21]姜华龙，李萍，严跃龙，等.半无管化单次微通道经皮肾镜与输尿管软镜治疗15～20 mm肾下盏结石的对比分析.临床泌尿外科杂志,2019,34(9):683-688.
[22]潘铁军，刘伟，杨家荣，等.输尿管软镜块状碎石法结合取石篮在治疗肾结石中的运用.临床泌尿外科杂志,2018,33(2):126-128.

备注/Memo

备注/Memo:
*通讯作者，Email：tomexu@163.com
更新日期/Last Update: 2020-11-13