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PCNL和RIRS治疗肾及输尿管上段结石的临床效果比较
作者:单勇1  陈明2  徐汉军1  刘仁杰1  陈双明1 
单位:1. 泰州市第二人民医院 泌尿外科,江苏 泰州 225300;
2. 东南大学附属中大医院 泌尿外科, 江苏 南京 210009
关键词:经皮肾镜 输尿管软镜 钬激光碎石术 肾和输尿管上段结石 
分类号:R692.4;R693.4;R616.5
出版年·卷·期(页码):2018·46·第十二期(1384-1387)
摘要:

目的:比较经皮肾镜钬激光碎石术(PCNL)和输尿管软镜下钬激光碎石术(RIRS)治疗肾和输尿管上段结石患者的临床效果。方法:2015年10月至2018年5月收治85例肾和输尿管上段结石患者,结石大小1~2 cm;经PCNL治疗者40例,RIRS治疗者45例;治疗8周后评估碎石效果。结果:RIRS组患者术中出血量、手术时间、卧床时间及住院时间均明显低于PCNL组(P<0.05);治疗后RIRS组患者血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和尿中肾损伤因子1(Kim-1)水平显著低于PCNL组(P<0.05);两组血肌酐(SCr)水平差异无统学意义(P>0.05);两组患者结石清除率差异无统计学意义(P>0.05);RIRS组患者不良反应发生率为8.00%,显著低于PCNL组的32.00%(P<0.05)。结论:在对肾和输尿管上段结石患者进行治疗时,RIRS具有较高的临床应用价值。

Objective: To compare the clinical effects of percutaneous nephrolithotomy (PCNL) and retrograde intra-renal surgery(RIRS) ureteroscope holmium laser lithotripsy in the treatment of renal and upper ureteral calculi.Methods: 85 patients with renal and ureteral calculi were admitted between October 2015 and May 2018. The stone size was 1-2 cm. 40 patients were treated by PCNL and 45 patients were treated by RIRS. The effect of lithotripsy was evaluated and compared after 8 weeks of treatment.Results: The intraoperative blood loss, operation time, bed time and hospitalization time in the RIRS group were significantly less than those in the PCNL group (P<0.05). After treatment, the levels of blood NGAL and urinary Kim-1 were significantly lower in the RIRS group(P<0.05). There was no significant difference in the SCr level and stone clearance rate between the two groups. The incidence of adverse reactions in the RIRS group(8.00%) was significantly lower than that in the PCNL group(32.00%, P<0.05).Conclusion: RIRS ureteroscopic holmium laser lithotripsy may have high clinical value than PCNL in patients with upper kidney and ureteral calculi (less than 2 cm).

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