Chen Z H, Liu C, Li K W, Lai C, Wu Z Y, Zhu J M, Zhou J H, Xu K W
Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.
Department of Urology, Jiangmen Wuyi Traditional Chinese Medicine Hospital, Jiangmen 529000, China.
Zhonghua Yi Xue Za Zhi. 2021 Oct 19;101(38):3127-3133. doi: 10.3760/cma.j.cn112137-20210316-00665.
To evaluate the feasibility and safety of Sotn ureterorenoscope combined with flexible ureteroscope on managing complex renal stones. Patients treated with the Sotn ureterorenoscope combined with flexible ureteroscope between January 2010 and December 2019 were employed from the Sun Yat-sen Memorial Hospital of Sun Yat-sen University and Jiangmen Wuyi Traditional Chinese Medicine Hospital. The patients' information of age, gender, comorbidities, stone characteristics (stone size, hounsfield units, stone composition, stone location, etc.), operative time and console time, stone-free rate (SFR), and perioperative complication rate were collected. The primary outcome was defined as primary SFR in 1 month of operation, and the secondary outcome was the perioperative complication rate. The differences in preoperative and postoperative data between patients with different kinds of stones were compared. A total of 347 patients were included in the study, with 220 males and 127 females. The age [(,)] was 51 (42, 58) years. There were 94 patients suffered from multiple renal stones and 253 patients with staghorn renal stones. The operative time and console time age [(,)] for all patients were 87 (55, 115) min and 59 (27, 75) min, respectively. The primary SFR was 81.3% [83.8% for multiple renal stones and 74.5% for staghorn renal stones (=0.048)]. Complications occurred in 80 patients (23.1%), of which 79 cases were classified as Clavien-Dindo grade 1-2, and 1 case (0.3%) was grade 3-4. For patients with multiple renal stone, compared with the residual stone group, the complete stone-free group had smaller stone size [15.5 (12.0, 21.0) vs 22.0 (17.5, 28.1) mm, <0.001], and lower hounsfield units [920.0 (658.0, 1 172.5) vs 1 125.0 (944.9, 1 247.5), =0.022]. Patients with complications had longer operative time than those without complications [60.0 (38.5, 90.0) vs 75.0 (51.3, 110.0) min, =0.022]. The SFR was higher in patients with stones size ≤ 20 mm compared to those with stones size > 20 mm (91.8% vs 67.5%, <0.001), while the difference in complication rate was not statistically significant (>0.05). In the staghorn renal stones group, compared with the residual stone group, the complete stone-free group had smaller stone size [35.0 (25.8, 45.3) vs 53.5 (39.3, 67.5) mm, <0.001]. Patients with complications had larger stone size than those without complications [43.5 (34.8, 56.5) vs 36.0 (27.0, 50.0) mm, =0.007]. Patients with stone size ≤ 40 mm had higher SFR (87.5% vs 55.3%, <0.001) and lower complication rate(10.7% vs 31.6%, =0.012) compared to those with stone size >40 mm. Sotn ureterorenoscope combined with flexible ureteroscope is an effective and safe choice for the treatment of complex renal calculi.
评估索通输尿管肾镜联合软性输尿管镜治疗复杂性肾结石的可行性和安全性。选取2010年1月至2019年12月在中山大学孙逸仙纪念医院和江门市五邑中医院接受索通输尿管肾镜联合软性输尿管镜治疗的患者。收集患者的年龄、性别、合并症、结石特征（结石大小、亨氏单位、结石成分、结石位置等）、手术时间和操作时间、结石清除率（SFR）以及围手术期并发症发生率等信息。主要结局定义为术后1个月的首次结石清除率，次要结局为围手术期并发症发生率。比较不同类型结石患者术前和术后数据的差异。本研究共纳入347例患者，其中男性220例，女性127例。年龄[（，）]为51（42，58）岁。多发性肾结石患者94例，鹿角形肾结石患者253例。所有患者的手术时间和操作时间年龄[（，）]分别为87（55，115）分钟和59（27，75）分钟。首次结石清除率为81.3%[多发性肾结石为83.8%，鹿角形肾结石为74.5%（P = 0.048）]。80例患者（23.1%）发生并发症，其中79例为Clavien-Dindo 1-2级，1例（0.3%）为3-4级。对于多发性肾结石患者，与残留结石组相比，结石完全清除组的结石尺寸更小[15.5（12.0，21.0） vs 22.0（17.5，28.1）mm，P <0.001]，亨氏单位更低[920.0（658.0，1172.5） vs 1125.0（944.9，1247.5），P = 0.022]。发生并发症的患者手术时间比未发生并发症的患者更长[60.0（38.5，90.0） vs 75.0（51.3，110.0）分钟，P = 0.022]。结石尺寸≤20 mm患者的结石清除率高于结石尺寸>20 mm的患者（91.8% vs 67.5%，P <0.001），而并发症发生率差异无统计学意义（P>0.05）。在鹿角形肾结石组中，与残留结石组相比，结石完全清除组的结石尺寸更小[35.0（25.8，45.3） vs 53.5（39.3，67.5）mm，P <0.001]。发生并发症的患者结石尺寸大于未发生并发症的患者[43.5（34.8，56.5） vs 36.（27.0，50.0）mm，P = 0.007]。与结石尺寸>40 mm的患者相比，结石尺寸≤40 mm的患者结石清除率更高（87.5% vs 55.3%，P <0.001），并发症发生率更低（10.7% vs 31.6%，P = 0.012）。索通输尿管肾镜联合软性输尿管镜是治疗复杂性肾结石的一种有效且安全的选择。
