Department of Urology, Wonkwang University Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Korea.
Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2022 May;63(5):440-445. doi: 10.3349/ymj.2022.63.5.440.
This study presents our initial experience with endoscopic combined intrarenal surgery (ECIRS) for large renal stones and compares the results of a propensity score-matched cohort of patients undergoing shock-wave lithotripsy (SWL).
A total of 100 adults underwent ECIRS for renal stones between August 2017 and January 2019. For comparison, 2172 patients who underwent a first session of SWL between January 2005 and May 2018 were included in the SWL cohort. Propensity score matching was performed using maximal stone length (MSL), mean stone density (MSD), and stone heterogeneity index (SHI) scores. Stone-free rate (SFR) and success rate were compared between ECIRS and SWL.
In the ECIRS group, the mean MSL, mean MSD, and mean SHI were 28.7±15.2 mm, 1013.9±360.0 Hounsfield units (HU), 209.4±104.0 HU, respectively. The SFR was 70%, and the success rate was 82.0% in this group. Although the ECIRS group had larger, harder, and more homogeneous stones than the SWL group, ECIRS showed a higher SFR and success rate than SWL. After propensity-score matching, SFR and success rate remained higher with ECIRS than with SWL (both, <0.001). In multivariate logistic regression, smaller stone size [odds ratio (OR): 0.947, 95% confidence interval (CI): 0.913-0.979, =0.002] and lower Seoul National University Renal Stone Complexity score (OR: 0.759, 95% CI: 0.610-0.935, =0.011) were independent predictors of successful ECIRS.
ECIRS showed a higher SFR and success rate than SWL for large renal stones. Smaller stone size and lower complexity of stones were associated with a higher likelihood of successful ECIRS.
本研究介绍了我们在经皮肾镜联合肾内手术（ECIRS）治疗大肾结石方面的初步经验，并比较了接受体外冲击波碎石术（SWL）的患者的倾向评分匹配队列的结果。
2017 年 8 月至 2019 年 1 月期间，共有 100 名成年人接受了 ECIRS 治疗肾结石。为了进行比较，2005 年 1 月至 2018 年 5 月期间接受了第一次 SWL 治疗的 2172 名患者被纳入 SWL 队列。使用最大结石长度（MSL）、平均结石密度（MSD）和结石异质性指数（SHI）评分进行倾向评分匹配。比较 ECIRS 和 SWL 的结石清除率（SFR）和成功率。
在 ECIRS 组中，平均 MSL、平均 MSD 和平均 SHI 分别为 28.7±15.2mm、1013.9±360.0 亨氏单位（HU）和 209.4±104.0 HU。该组的 SFR 为 70%，成功率为 82.0%。尽管 ECIRS 组的结石较大、较硬且更均匀，但与 SWL 相比，ECIRS 的 SFR 和成功率更高。经过倾向评分匹配后，ECIRS 的 SFR 和成功率仍高于 SWL（均<0.001）。在多变量逻辑回归中，较小的结石大小[优势比（OR）：0.947，95%置信区间（CI）：0.913-0.979，=0.002]和较低的首尔国立大学肾结石复杂性评分（OR：0.759，95%CI：0.610-0.935，=0.011）是 ECIRS 成功的独立预测因素。
与 SWL 相比，ECIRS 治疗大肾结石的 SFR 和成功率更高。较小的结石大小和较低的结石复杂性与 ECIRS 成功的可能性更高相关。
