输尿管软镜和经皮肾镜联合EMS钬激光治疗不完全性鹿角状肾结石的效果比较

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摘要目的比较输尿管软镜碎石术（FURS）和经皮肾镜碎石术（PCNL）联合EMS 钬激光治疗不完全性鹿角状肾结石的临床效果。方法选取2016年3月～2019年12月成都市金牛区人民医院收治的103 例不完全性鹿角状肾结石患者作为研究对象，根据治疗方式不同分为输尿管软镜组48 例，经皮肾镜组55 例。比较两种手术方式联合EMS 钬激光治疗不完全性鹿角状肾结石患者的手术时间、术中出血量、术后血红蛋白下降量、住院费用、住院时间、Ⅰ期取石成功率、总结石清除率和并发症总发生率。结果 FURS 组患者的手术时间长于PCNL 组，住院费用高于PCNL 组，术中出血量少于PCNL 组、术后血红蛋白下降量低于PCNL 组，术后住院时间短于PCNL 组，Ⅰ期取石成功率低于PCNL 组，差异有统计学意义（P＜0.05）。两组的总结石清除率及并发症总发生率比较，差异无统计学意义（P＞0.05）。其中FURS 组7 例术后行Ⅱ期EWSL 治疗，PCNL 组4 例术后行Ⅱ期EWSL 治疗。结论 FURS 联合钬EMS 激光碎石和PCNL 联合EMS 钬激光碎石治疗不完全性鹿角状结石皆是安全有效的手术方法。与输尿管软镜碎石术相比，经皮肾镜碎石术的优点主要是清石率高和手术时间短，更适合直径＞20 mm 的肾结石，特别是巨大的完全性鹿角状肾结石的治疗。输尿管软镜联合钬EMS 激光碎石可减少患者术中的出血量，降低术后出血率，缩短住院时间。

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关键词 ：输尿管软镜碎石术, 经皮肾镜碎石术, 钬激光, 不完全性鹿角状肾结石

Abstract：Objective To compare the clinical efficacy of flexible ureteroscopic lithotripsy (FURS) and percutaneous nephrolithotripsy (PCNL) combined with EMS holmium laser in the treatment of incomplete staghorn renal calculi.Methods A total of 103 patients with incomplete staghorn nephrolithiasis admitted to Sichuan Provincial People′s Hospital Jinniu Hospital from March 2016 to December 2019 were selected as the research objects and divided into the FURS group(48 cases)and the PCNL group(55 cases)according to different treatment methods.The operative time,intraoperative blood loss, postoperative haemoglobin decline, hospital expenses, length of stay, success rate of stone extraction in phase Ⅰ, total stone clearance rate and total incidence of complications of two surgical methods combined with EMS holmium laser in the treatment of incomplete staghorn renal calculi were compared.Results The operation time of FURS group was longer than that of PCNL group, intraoperative blood loss of FURS group was less than that of PCNL group, the postoperative haemoglobin decline of FURS group was lower than that of PCNL group, the length of stay of FURS group was shorter than that of PCNL group, success rate of stone extraction in phase Ⅰof FURS group was lower than that of PCNL group, the differences were statistically significant (P＜0.05).There were no significant differences between the two groups in the total stone clearance rate and the total incidence of complications (P＞0.05).And seven cases of FURS group employed postoperative EWSL treatment, four cases of PCNL group employed EWSL treatment.Conclusion FURS combined with EMS holmium laser lithotripsy and PCNL combined with EMS holmium laser lithotripsy are safe and effective methods for the treatment of incomplete staghorn calculi.Compared with flexible ureteroscopy, percutaneous nephroscope lithotripsy has a high rate of stone clearance and shorter operation time, it is more suitable for ＞20 mm diameter kidney stones, especially the complete large staghorn stones.It can decrease intraoperative blood loss, reduce the postoperative bleeding rate, and shorter the length of stay of FURS combined with EMS holmium laser lithotripsy.

Key words： Flexible ureteroscopy lithotripsy Percutaneous nephrolithotripsy Holmium laser Incomplete staghorn renal calculi

引用本文:

朱科; 李建;周建; 白天;曹波; 文刚;唐箐箐; 黄翔. 输尿管软镜和经皮肾镜联合EMS钬激光治疗不完全性鹿角状肾结石的效果比较[J]. 中国当代医药, 2021, 28(10): 130-133.
ZHU Ke1 LI Jian;ZHOU Jian; BAI Tian;CAO Bo;WEN Gang;TANG Jing-jing;HUANG Xiang. Comparison of the efficacy of flexible ureteroscopy or percutaneous nephroscopy combined with EMS holmium laser on the treatment of incomplete staghorn kidney stones. 中国当代医药, 2021, 28(10): 130-133.

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