Xu Gang, Wen Jiaming, Li Zhongyi, Zhang Zhewei, Gong Xiuqing, Chen Jimin, Du Chuanjun
Department of Urology, The Second Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou 310009, China.
Department of Urology, The Third People's Hospital of Hangzhou Hangzhou 310009, China.
Int J Clin Exp Med. 2015 Mar 15;8(3):4501-7. eCollection 2015.
A certain proportion of patients with initial Percutaneous nephrolithotripsy (PCNL) management require ancillary procedures to increase the stone-free rate. In this study, we aim to analyze the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy (F-UL) for treatment of residual calculi after PCNL by comparison with extracorporeal shockwave lithotripsy (SWL). Total of 96 patients with residual renal calculi (4 mm to 20 mm) after PCNL was enrolled from May 2010 to March 2013. They were randomly divided into two groups: US Group: patients were treated with F-UL; SWL Group: patients were treated with SWL. Follow-up was made one month and three months after treatment. The mean residual stone size after PCNL was 12.4 ± 4.3 mm in US group compared with 11.9 ± 4.5 in SWL group. The stone-free rate was 84.7% one month after surgical procedure in US group, this rate increased to 91.3% in the third months, while the stone-free rate in SWL group is 64.6% one month after treatment and 72.9% in the third month. For residual stone in lower calyx, the stone-free rate three month after treatment was 90.4% in US group compared to 65.2% in SWL group (P < 0.05). The overall complication rate was low in both groups, no severe complication was found. Both F-UL and SWL are safe and effective methods for residual calculi after PCNL, without severe complications. F-UL provided significantly higher stone-free rate compared with SWL, especially for low-pole calculi.
一部分接受初始经皮肾镜取石术（PCNL）治疗的患者需要辅助手术来提高结石清除率。在本研究中，我们旨在通过与体外冲击波碎石术（SWL）比较，分析输尿管软镜联合钬激光碎石术（F-UL）治疗PCNL术后残余结石的有效性和安全性。2010年5月至2013年3月，共纳入96例PCNL术后残余肾结石（4毫米至20毫米）患者。他们被随机分为两组：输尿管软镜组：患者接受F-UL治疗；体外冲击波碎石组：患者接受SWL治疗。治疗后1个月和3个月进行随访。输尿管软镜组PCNL术后平均残余结石大小为12.4±4.3毫米，体外冲击波碎石组为11.9±4.5毫米。输尿管软镜组术后第1个月结石清除率为84.7%，第3个月升至91.3%，而体外冲击波碎石组治疗后1个月结石清除率为64.6%，第3个月为72.9%。对于下盏残余结石，输尿管软镜组治疗后3个月结石清除率为90.4%，体外冲击波碎石组为65.2%（P<0.05）。两组总体并发症发生率较低，未发现严重并发症。F-UL和SWL都是治疗PCNL术后残余结石的安全有效方法，无严重并发症。与SWL相比，F-UL的结石清除率显著更高，尤其是对于下极结石。
