针状肾镜联合输尿管软镜治疗1~2cm肾下盏结石的疗效分析

doi:10.19558/j.cnki.10-1020/r.2022.03.004

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摘要 目的: 比较两种不同术式治疗1~2cm肾下盏结石的安全性及有效率。方法: 自2016年6月至2021年1月在北京清华长庚医院泌尿外科住院的83例患者纳入该研究,其中36名患者行针状肾镜结合逆行输尿管软镜碎石取石术（NR组）,47例行逆行输尿管软镜碎石取石术（RIRS组）。用200 µm钬激光碎石,碎片可用取石网篮取出。分析两组患者的临床资料。结果: 两组患者的基本临床资料之间无明显差别,NR组患者的手术时长明显缩短[NR组(70.1±22.5) min vs. RIRS组(96.2±31.2) min, P=0.002],平均术后失血量相近(7.5±1.3) g/dl vs. (8.1±1.6) g/dl, P=0.08）。NR组的4例患者术后出现Clavien-Dindo Ⅰ~Ⅱ级并发症,RIRS组的5例患者术后出现Clavien-Dindo Ⅱ级并发症。二者的术后平均住院日无明显差别[（1.4±0.5)天 vs. (1.3±0.5)天]。术后三月NR组的清石率为86.1%,RIRS组为74.5%。结论: 对于1~2cm肾下极结石,针状肾镜结合输尿管镜取石术安全且有效。

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	曾雪
	靳松
	姬超岳
	胡卫国
	张刚
	白文洁
	王碧霄
	肖博
	李建兴

关键词 ：肾镜取石术, 经皮, 输尿管软镜

Abstract：Objective: To compare the safety and efficiency of two methods for the treatment of 1-2 cm lower-pole renal culculi. Methods: A total of 83 consecutive patients with 1-2 cm lower-pole renal culculi who underwent combined needle-nephroscope and the flexible ureteroscope,retrograde （f-URS）（NR group,n=36） or retrograde intrarenal surgery （RIRS group,n=47） between June 2016 and January 2021 were retrospectively analyzed. Lithotripsy was established using a 200-µm holmium laser fiber. Fragments were retrieved with a basket from the ureteral access sheath （UAS）,if necessary. Preoperative,intraoperative,and postoperative parameters were analyzed between the two groups. Results: The two groups had similar baseline preoperative parameters in patient characteristics and stone features. The mean operative duration was significantly shorter in NR group than in RIRS group [（70.1±22.5）min vs. （96.2±31.2）min,P=0.002]. The mean hemoglobin loss in NR group was comparable to RIRS group [（7.5±1.3）g/dL vs. （8.1±1.6）g/dL,P=0.08]. Minor complications （Clavien-Dindo grade Ⅰ-Ⅱ） occurred in 4 patients in NR group,and 5 patients with grade 2 in RIRS group. The post-operative hospital stay showed no significant difference between the two groups [（1.4±0.5）d vs. （1.3±0.5）d,P=0.15]. The 3-month stone-free rate （SFR） was 86.1% （31/36） in NR group,which was significantly higher than in RIRS group [74.5% （35/47）]. Conclusion: Needle-perc combined with f-URS to treat 1-2 cm lower-pole stones was safe and feasible.

Key words： nephrolithotomy percutaneous flexible ureteroscopy

收稿日期: 2022-01-06

基金资助:北京市医管局 2021年临床医学发展专项“扬帆”计划（XMLX202118）

通讯作者: 肖博, beidaxiaobo@163.com;李建兴, lijianxing2015@163.com

引用本文:

曾雪, 靳松, 姬超岳, 胡卫国, 张刚, 白文洁, 王碧霄, 肖博, 李建兴. 针状肾镜联合输尿管软镜治疗1~2cm肾下盏结石的疗效分析[J]. 微创泌尿外科杂志, 2022, 11(3): 161-165.
Zeng Xue, Jin Song, Ji Chaoyue, Hu Weiguo, Zhang Gang, Bai Wenjie, Wang Bixiao, Xiao Bo, Li Jianxing. Analysis of the efficacy of needle nephroscopy combined with ureteroscopy in the treatment of 1~2cm infrarenal calcium stones. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2022, 11(3): 161-165.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1768.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2022/V11/I3/161

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