目的 探讨比较输尿管软镜碎石术(RIRS)与经皮肾镜取石术(PCNL)治疗2~2 .5 cm肾下盏结石的疗效.方法 回顾性分析2013年1月至2014年11月34例收治的2~2 .5 cm肾下盏结石患者的临床资料及治疗方法 ,其中RIRS组15例 ,PCNL组19例 ;比较两组的年龄、结石大小、手术时间、术后血红蛋白下降值、术后住院天数、住院费用、清石率和并发症.结果 RIRS组和PCNL组年龄分别为(49 .13 ± 12 .29)岁、(50 .53 ± 11 .78)岁 ,结石大小为(2 .14 ± 0 .11)cm、(2 .23 ± 0 .10)cm ,组间比较无统计学差异(P>0 .05);RIRS组和PCNL组手术时间分别为(70 .82 ± 14 .85)min、(45 .32 ± 6 .21)min ,术后血红蛋白下降值(4 .20 ± 1.32)g/L、(9.42±2.99)g/L,术后住院天数(3.60±0.74)d、(7.21±1.08)d,住院费用(12797.80±949.35)元、(21695.05± 2370 .82)元 ,清石率73% (11/15)、89% (17/19) ,组间比较均有统计学差异(P<0 .05).RIRS组术后出现发热1例 ,PCNL组术后出现发热1例、术后明显出血2例 ,均经保守治疗治愈.结论 对于2~2. 5 cm肾下盏结石 ,经皮肾镜仍是首选 ,输尿管软镜碎石具有创伤小、住院天数少、费用低及并发症少优势 ,仍是一种可靠选择 ,并有望替代PC N L.
Objective To compare the therapeutic effects of retrograde intrarenal surgery (RIRS) and percutaneousnephrolithotomy (PCNL) in treating patients with lower calyceal renal calculi of 2 ~ 2.5 cm .Methods Clinical data of 45cases of lower calyceal renal calculi ranging from 2~ 2.5 cm treated by either RIRS ( n =15) or PCNL ( n =19) between Jan .2013 and Nov .2014 were retrospectively analyzed .Patients' age ,stone size ,operation time ,hemoglobin decline ,postoperativehospital stay ,hospitalization expenses ,stone free rate and complications were compared between the two groups .ResultsThe mean age and stone size of the RIRS group and PCNL group were (49.13 ±12.29) vs .(50.53 ±11.78) years ,and(2.14 ± 0.11) vs .(2.53 ± 0.10) cm ,with no significant difference between the two groups ( P >0.05) .The operation time ,hemoglobin decline ,postoperative hospital stay ,hospitalization expenses ,stone free rate of the RIRS group and PCNL groupwere (70.82 ± 14.85) vs .(45.32 ± 6.21)min ,(4.20 ± 1.32) vs .(9.42 ±2.99)g/L ,(3.60 ±0.74) vs .(7.21 ±1.08)d ,(12797.80 ± 949.35) vs .(21695.05 ± 2370.82) RMB ,73% (11/15) vs .89% (17/19) ,and there were statistical differences betweenthe two groups ( P <0.05) .In the RIRS group ,1 case developed postoperative fever .In the PCNL group ,fever occurredin 1 case and haemorrhage occurred in 2 cases ,which were cured by conservative treatment .Conclusions In treatinglower calyceal renal calculi of 2 ~ 2.5 cm ,PCNL is still preferred .RIRS has the advantages of less trauma and complication ,lower expenses and shorter hospital stay .It is reliable and may become an alternative treatment to PCNL in selected cases withlarger lower calyceal renal calculi .