逆行性肾内手术与改良超微经皮肾镜取石术治疗下极肾结石（1.5-3.5cm）的对比分析。
Comparative analysis of retrograde intrarenal surgery and modified ultra-mini percutaneous nephrolithotomy in management of lower pole renal stones (1.5-3.5 cm).
机构信息
Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107 West Yanjiang Road, Guangzhou, 510210, China.
Department of Urology, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal.
出版信息
BMC Urol. 2020 Mar 16;20(1):27. doi: 10.1186/s12894-020-00586-6.
BACKGROUND
To compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and modified Ultra-mini percutaneous nephrolithotomy (UMP) in semi-supine combined lithotomy position for the management of 1.5-3.5 cm lower pole renal stones (LPSs).
METHODS
A total of 63 patients with 1.5-3.5 cm LPSs who underwent RIRS (n = 33) or modified UMP (n = 30) in diameter between January 2017 and January 2019 were analyzed retrospectively. Modified UMP was performed in semi-supine combined lithotomy position and a 9.5/11.5 F ureteral access sheath (UAS) was inserted during the procedure in order to maintain low pelvic pressure and to facilitate the removal of stone fragments. Base-line parameters, stone characteristics, illness condition, operation time, postoperative hemoglobin (Hb) drop, postoperative creatinine (Cr) elevation, length of hospital stay, length of postoperative hospital stay, stone-free rate (SFR) and complications were compared between the two groups.
RESULTS
There were no significant differences between the two groups in base-line parameters, stone characteristics and illness condition. The mean operating time of RIRS group was longer than UMP group (95.61 ± 21.9 vs. 55.0 ± 16.1 min, p < 0.001). The mean postoperative Hb drop was less in RIRS group (7.42 ± 4.7 vs. 15.70 ± 9.8 g/L, p < 0.001). The length of hospital stay and postoperative hospital stay for RIRS were shorter than UMP (4.76 ± 1.1 vs. 5.83 ± 0.8 d, p < 0.001, 2.97 ± 0.9 vs. 4.07 ± 0.9 d, p < 0.001). The Early SFR was higher in UMP group (54.5 vs. 80.0%, p < 0.050) while SFR at 1-month and 3-months postoperatively was similar in both groups (p = 0.504, p = 0.675). There were no significant differences between the two groups in complications (p = 0.228).
CONCLUSION
For patients with 1.5-3.5 cm LPSs, both modified UMP and RIRS are safe and viable. The modified UMP technique was used in this study, application semi-supine combined lithotomy position and the retention of UAS can improve the surgical efficiency and maintain low pressure perfusion in the kidney, which resulted in superior treatment efficacy. Therefore, we highly recommend this technique for LPSs with heavy stone burdens.
背景
比较逆行肾盂内碎石术（RIRS）和改良超微经皮肾镜取石术（UMP）在半仰卧位联合截石位治疗 1.5-3.5cm 下极肾结石（LPSs）的安全性和疗效。
方法
回顾性分析 2017 年 1 月至 2019 年 1 月期间直径为 1.5-3.5cm 的 LPSs 患者 63 例，采用 RIRS（n=33）或改良 UMP（n=30）治疗。改良 UMP 在半仰卧位联合截石位进行，手术中插入 9.5/11.5F 输尿管取石鞘（UAS），以维持低盆腔压力并方便结石碎片的清除。比较两组患者的基线参数、结石特征、病情、手术时间、术后血红蛋白（Hb）下降、术后肌酐（Cr）升高、住院时间、术后住院时间、结石清除率（SFR）和并发症。
结果
两组患者的基线参数、结石特征和病情均无统计学差异。RIRS 组的手术时间长于 UMP 组（95.61±21.9 分钟比 55.0±16.1 分钟，p<0.001）。RIRS 组术后 Hb 下降幅度小于 UMP 组（7.42±4.7 克/分升比 15.70±9.8 克/分升，p<0.001）。RIRS 组的住院时间和术后住院时间短于 UMP 组（4.76±1.1 天比 5.83±0.8 天，p<0.001，2.97±0.9 天比 4.07±0.9 天，p<0.001）。UMP 组早期 SFR 较高（54.5%比 80.0%，p<0.050），但两组术后 1 个月和 3 个月 SFR 相似（p=0.504，p=0.675）。两组并发症无统计学差异（p=0.228）。
结论
对于 1.5-3.5cm LPSs 的患者，改良 UMP 和 RIRS 均安全可行。本研究采用改良 UMP 技术，应用半仰卧位联合截石位并保留 UAS，可提高手术效率，维持肾脏低压灌注，从而获得更好的治疗效果。因此，我们强烈推荐该技术用于结石负荷较重的 LPSs。
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