Minimally Invasive Unit, Department of Urology, Golda Hospital, Rabin Medical Center, Petach Tikva, Israel.
Department of Urology, Beilinson Hospital, Rabin Medical Center, Petach Tikva, Israel.
World J Urol. 2017 Dec;35(12):1947-1954. doi: 10.1007/s00345-017-2075-8. Epub 2017 Jul 29.
To investigate the performance of retrograde intrarenal surgery (RIRS) for the 1-2 cm renal stone size range in comparison to smaller stones.
From a data base of 3000 ureteroscopies between 2004 and 2014, 635 consecutive patients underwent RIRS for renal stones. Patients were divided to three groups according to their renal stone size (<10, 10-15, 15-20 mm). Preoperative, operative, stone free rate (SFR) and follow-up data were analyzed and compared.
The SFR for the three groups was 94.1, 90.1 and 85%, respectively. Patients with renal stone size above 15 mm had a statistically significantly lower SFR. The efficiency quotient calculated for stones larger and smaller than 15 mm was 83.9 vs. 91.8%, respectively (p < 0.01). The mean operative time and hospital stay were longer for patients with renal stones larger than 15 mm (73.6 ± 29.9 vs. 53 ± 19.4 min, p < 0.01 and 2.2 ± 2 vs. 1.8 ± 1.8 days, p = 0.031, respectively). Moreover, the complication rate was almost two times higher (10 vs 5.4%, p = 0.08). Concomitant ureteral stones and older age were independent predictors of failure in the large stone group.
While the overall SFR following RIRS for renal stones up to 2 cm is generally high, the SFR for 15-20 mm stones is significantly lower, with a longer operating time and hospital stay, and a higher complication rate.
研究逆行肾内手术（RIRS）治疗 1-2cm 肾结石与治疗较小结石的疗效。
回顾 2004 年至 2014 年间数据库中 3000 例输尿管镜检查，635 例连续患者接受 RIRS 治疗肾结石。根据肾结石大小将患者分为三组（<10、10-15、15-20mm）。分析比较术前、术中、无结石率（SFR）和随访数据。
三组的 SFR 分别为 94.1%、90.1%和 85%。肾结石大小>15mm 的患者 SFR 统计学上显著降低。计算>15mm 和<15mm 的结石的效率商分别为 83.9%和 91.8%（p<0.01）。肾结石>15mm 的患者手术时间和住院时间更长（73.6±29.9 分钟比 53±19.4 分钟，p<0.01 和 2.2±2 天比 1.8±1.8 天，p=0.031）。此外，并发症发生率几乎高出两倍（10%比 5.4%，p=0.08）。同时伴有输尿管结石和年龄较大是大结石组失败的独立预测因素。
虽然 RIRS 治疗最大至 2cm 肾结石的总体 SFR 较高，但 15-20mm 结石的 SFR 显著降低，手术时间和住院时间更长，并发症发生率更高。
