中等大小肾结石应首选哪种治疗方法？超微经皮肾镜取石术还是逆行性肾内手术？

Which Should be Preferred for Moderate-Size Kidney Stones? Ultramini Percutaneous Nephrolithotomy or Retrograde Intrarenal Surgery?

作者信息

Demirbas Arif, Resorlu Berkan, Sunay Mehmet Melih, Karakan Tolga, Karagöz Mehmet Ali, Doluoglu Omer Gokhan

机构信息

Department of Urology, Ankara Training and Research Hospital , Ankara, Turkey .

出版信息

J Endourol. 2016 Dec;30(12):1285-1289. doi: 10.1089/end.2016.0370.

DOI:10.1089/end.2016.0370

PMID:27706948

Abstract

PURPOSE

Comparison of effectiveness and safety of ultramini percutaneous nephrolithotomy (UMPNL) and retrograde intrarenal surgery (RIRS) in treatment of moderate-sized renal stones.

MATERIAL AND METHODS

The patients scheduled for surgery attributable to renal stones with the greatest diameter of 10 to 25 mm were prospectively analyzed. Patients were randomized into groups with tossing a coin method. The patients who had UMPNL and RIRS were defined as Group I and Group II, respectively. The groups were compared for demograhic data, stone characteristics, operative and postoperative data, stone-free status, and the complications. Student's t-test and Pearson's Chi square tests were used for statistical analysis. p < 0.05 was considered as statistically significant.

RESULTS

There were 30 patients in Group I, and 43 patients in Group II. The groups were similar for age, gender, side of the stone, and surface area characteristics of the stone (p = 0.194, p = 0.470, p = 0.990, and p = 0.487, respectively). Stone-free rate was 80% (n = 24) in UMPNL, and 74.4% (n = 32) in RIRS (p = 0.579). Modified Clavien Classification Grade 1 to 2 and 3A to 3B complications were similar in two groups (p = 0.959 and p = 0.192, respectively). Comparison of stone-free rates was 93.3% in UMPNL, and 42.9% in RIRS groups for lower pole stones (p = 0.009). Groups I and II were significantly different for visual analog scale scores for postoperative pain (4.73 ± 1.25 vs 2.30 ± 1.12), hospital stay (2.46 ± 3.02 vs 1.37 ± 1.48 days), and time to return to normal daily life (11.26 ± 5.55 vs 6.65 ± 4.30 days) (p < 0.001, p < 0.001, and p < 0.001, respectively).

CONCLUSION

Both UMPNL and RIRS procedures are effective and safe methods in treatment of middle-sized renal stones. However, UMPNL is more effective than RIRS in treatment of lower pole stones. RIRS is more advantageous when loss from work is taken into consideration.

摘要

目的

比较超微经皮肾镜取石术（UMPNL）与逆行肾内手术（RIRS）治疗中等大小肾结石的有效性和安全性。

材料与方法

对计划接受手术治疗、最大直径为10至25毫米的肾结石患者进行前瞻性分析。采用抛硬币法将患者随机分组。接受UMPNL和RIRS的患者分别定义为I组和II组。比较两组的人口统计学数据、结石特征、手术及术后数据、结石清除情况和并发症。采用学生t检验和Pearson卡方检验进行统计分析。p < 0.05被认为具有统计学意义。

结果

I组有30例患者，II组有43例患者。两组在年龄、性别、结石所在侧和结石表面积特征方面相似（分别为p = 0.194、p = 0.470、p = 0.990和p = 0.487）。UMPNL的结石清除率为80%（n = 24），RIRS为74.4%（n = 32）（p = 0.579）。两组1至2级和3A至3B级改良Clavien分类并发症相似（分别为p = 0.959和p = 0.192）。下极结石的UMPNL组结石清除率为93.3%，RIRS组为42.9%（p = 0.009）。I组和II组在术后疼痛视觉模拟评分（4.73 ± 1.25 vs 2.30 ± 1.12）、住院时间（2.46 ± 3.02 vs 1.37 ± 1.48天）和恢复正常日常生活时间（11.26 ± 5.55 vs 6.65 ± 4.30天）方面存在显著差异（分别为p < 0.001、p < 0.001和p < 0.001）。