三种微创手术治疗直径2 cm内肾下盏结石的效果比较

目的比较经皮肾镜碎石取石术（PCNL）、微通道经皮肾取石术（MPCNL）和输尿管软镜碎石术（FURL）治疗直径2 cm内肾下盏结石的效果。方法选取直径2 cm内肾下盏结石患者150例，随机分成3组，每组50例，分别行PCNL、MPCNL和FURL，比较3种方法手术时间、术中出血量、住院时间、术后下床活动时间、术后第1天疼痛视觉模拟量表（VAS）评分、术后即时和最终结石清除率和手术并发症发生情况。结果MPCNL组手术时间最短，术中出血量和术后下床活动时间均低于PCNL组患者（P<0.05）。FURL组患者术中出血量、住院时间、术后下床活动时间以及术后第1天VAS评分均显著低于PCNL组MPCNL组（P<0.05）。PCNL、MPCNL和FURL组即时和最终结石清除率均较高，3组差异无统计学意义（P>0.05）。FURL组患者术后并发症总发生率低于PCNL和MPCNL组患者（P<0.05）。结论PCNL、MPCNL和FURL均为治疗直径2 cm内肾下盏结石的有效手段，其中FURL较PCNL和MPCNL创伤小，术后康复快，并发症发生率低，值得在临床上推广。

Effect comparison of 3 minimally invasive surgeries for subrenal calyx calculi under 20 mm

ObjectiveTo compare therapeutic effects of percutaneous nephrolithotomy (PCNL), minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy (FURL) for subrenal calyx calculi under 20 mm.Methods150 patients with subrenal calyx calculi <20 mm were randomly assigned to three groups ( n=50). Patients in different groups received PCNL, MPCNL and FURL respectively, and the operation time, bleeding volume, length of stay, postoperative out-of-bed activity time, visual analogue scale (VAS) scores at the first postoperative day, stone free rates and incidence rate of postoperative complications in each group were recorded and compared.ResultsOperation time in the PCNL group was the shortest among three groups, and its bleeding volume and ambulation time were significantly lower compared to those in PCNL group (P<0.05). Bleeding volume, length of stay, post-operative out-of-bed activity time and VAS scores on the first postoperative day in FURL group were significantly lower than those in PCNL group and MPCNL group (P<0.05). Instant and final stone free rates were high in PCNL, MPCNL and FURL group, and there were no significant differences among them (P>0.05). The incidence rate of postoperative complication was lower in FURL group than that in PCNL and MPCNL group (P<0.05).ConclusionPCNL, MPCNL and FURL are effective treatments for subrenal calyx calculi under 20 mm. FURL, with shorter recovery time and lower incidence rate of postopertive complications, is less invasive compared to PCNL and MPCNL, thus worthy of clinical application and promotion.