输尿管软镜碎石术治疗铸型肾结石经皮肾镜碎石术后残石的临床研究

目的探讨输尿管软镜碎石术(RIRS)治疗铸型肾结石经皮肾镜碎石(PCNL)术后残石的有效性和安全性。方法回顾性分析该科2015年7月-2018年8月68例行多期碎石手术的铸型肾结石患者的临床资料,根据患者及家属的选择分为两组,PCNL组是二期手术方式为PCNL的36例患者,RIRS组是二期手术方式为RIRS的32例患者。观察68例患者的临床疗效。结果所有手术均顺利完成,无1例出现严重并发症。两组患者均取得良好的清石率,清石率RIRS组87.50%和PCNL组91.67%,差异无统计学意义(P>0.05)。在术后平均住院时间、术中出血量、术后24 h血红蛋白平均下降值、术后24 h疼痛评分(VAS)等方面,RIRS组均明显优于PCNL组,差异有统计学意义(P<0.05);在手术时间方面,RIRS组手术时间明显长于PCNL组,差异有统计学意义(P<0.05)。术后复查,RIRS组有4例患者需进一步治疗,三期手术/体外冲击波碎石术(ESWL)治疗率12.50%,PCNL组有3例患者需进一步治疗,三期手术/ESWL治疗率为8.33%,差异无统计学意义(P>0.05)。治疗后1个月复查腹部CT,两组患者均未见结石残留。结论处理铸型肾结石PCNL术后残石,与二期单通道/多通道PCNL相比,RIRS具有术中出血少、手术创伤小、术后疼痛轻、术后住院时间短和手术并发症少等优势,尤其适合治疗铸型肾结石PCNL术后中上盏残石。

Retrograde intrarenal surgery in treatment of residual calculi after percutaneous nephrolithotomy for cast kidney stones

Objective To investigate the efficacy and safety of retrograde intrarenal surgery(RIRS) in treatment of residual kidney stones after PCNL in patients with cast kidney stones. Method From July 2015 to August 2018, 68 patients with cast renal calculi underwent multi-stage lithotripsy were retrospectively analyzed. They were divided into two groups according to the choice of the patients and their families. The patients in PCNL group were 36 patients with PCNL in the second stage of operation. The RIRS group consisted of 32 patients with RIRS in the second stage of operation. The clinical effects of 68 patients were observed. Result All the operations were successfully completed and no serious complications occurred. Good stone clearance rate was obtained in the two groups, which were 87.50% in RIRS group and 91.67% in PCNL group, respectively. There was no significant difference between the two groups(P > 0.05). The average hospitalization time, the amount of intraoperative bleeding, the average decrease of hemoglobin 24 hours after operation and the pain score of 24 hours after operation in RIRS group were significantly better than those in PCNL group(P < 0.05). In terms of operation time, the operation time in RIRS group was longer than that in PCNL group(P < 0.05). After operation, there were 4 patients in RIRS group who needed further treatment, the treatment rate of ESWL in third stage operation was 12.50%, 3 patients in ESWL group needed further treatment, and the rate of three stage operation/ESWL treatment was 8.33%, there was no significant difference(P > 0.05). Finally, 1 month after treatment, no residual stones were found in the two groups of abdominal CT. Conclusion RIRS compared with the second phase of single channel/multi-channel PCNL, RIRS with intraoperative bleeding, small surgical trauma, less postoperative pain, and shorter postoperative hospital stay, less complications, such as advantages, particularly suitable for treatment of residual kidney stones of upper renal pelvis and middle renal pelvis after PCNL in patients with cast kidney stones.