经皮肾镜碎石取石术与输尿管软镜碎石术治疗直径＞2cm孤立性肾结石的疗效对比

目的 比较经皮肾镜碎石取石术（PCNL）与输尿管软镜碎石术（FURS）治疗孤立性肾结石（结石直径2.0～4.5 cm）的疗效差异。方法 回顾性分析2012年8月至2018年5月本院收治的80例孤立性肾结石（结石直径2.0～4.5 cm）患者的临床资料，其中43例行PCNL术，37例行FURS术。比较两组患者的手术时间、术后住院时间、住院费用、术后血红蛋白下降水平、术后输血率、止血药使用率、术后发热和感染发生率、清石率，手术前后肾功能变化等指标。结果 手术时间PCNL组比FURS组短（P=0.039）；术后住院时间PCNL组比FURS组长（P<0.001）；平均住院费用PCNL组高于FURS组（P<0.001）；平均术后血红蛋白下降水平PCNL组多于FURS组（P=0.014）；术后输血率PCNL组高于FURS组（P=0.01）；PCNL组术后使用止血药有14例（32.5%），FURS组没有使用止血药的患者，差异具有统计学意义（P<0.001）。两组患者术后使用止痛药分别为11例（25.6%）和2例（5.4%）（P=0.015）。PCNL组术后7例出现发热，FURS组4例发热（P=0.479）。两组都没有出现尿源性脓毒血症的病例。一期清石率PCNL组（86%）高于FURS组（68%）（P=0.048），但总清石率两组差异无统计学意义（P=0.524）。PCNL组术后BUN水平下降（P=0.006），但Scr下降水平差异无统计学意义（P=0.089）；FURS组手术前后Scr和BUN水平差异均无统计学意义（P>0.05）。结论 孤立肾结石的治疗风险较大，PCNL和FURS均是治疗2.0～4.5 cm孤立性肾结石的有效的方法，其中PCNL有更高的一期清石率，但FURS术后并发症更少、术后住院时间更短。

Comparison of percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of stones(>2 cm) in patients with a solitary kidney

Objective  To compare the clinical efficacy of percutaneous neprolithotomy (PCNL) and flexible ureteroscopy (FURS) in the treatment of 2.0-4.5 cm stones in a solitary kidney．Methods  We retrospectively analyzed 80 cases of calculi in solitary kidney from August 2012 to May 2018, the sizes of the stones were 2.0-4.5 cm, 43 patients underwent PCNL and 37 patients underwent FURS. The patients'characteristics, stone features, operative time, postoperative hospital stay, hospitalization cost, incidence complications, stone-free rate and renal functions have been evaluated. Results   The clinical characteristic of the two groups were comparable.The operative time of PCNL group (103±36) min was shorter than that of FURS group (120±31)min (P=0.039).The  postoperative hospitalization stay of PCNL group (9.7±5.1) d was longer than that of FURS group (2.3±1.2) d (P<0.001).The average hospitalization expenses of the PCNL group (29796±10054)yuan were higher than that of the FURS group (19320±7546)yuan (P<0.001).The mean postoperative hemoglobin level of PCNL group (9.3±14.6) g /L was higher than that of FURS group (3.3±3.6)g /L (P=0.014). The postoperative blood transfusion rate of PCNL group was higher than that of FURS(P=0.010).There were 14 cases (32.5%) in the PCNL group using hemostatics after surgery, whereas there was nobody use hemostatics in FURS group, which was statistically significant(P<0.001). Eleven patients (25.6%) and 2 patients (5.4%) of postoperative were treated with pain reliever(P=0.015).There were 7 patients have fever in PCNL group and 4 cases in FURS group (P=0.479).There were no cases of urinary sepsis in either group.The rate of one-session stone removal of PCNL group (86%) was higher than that of FURS (68%) (P=0.048), but there was no significant difference between the two groups in total stone removal rate(P=0.524). Both the levels of serum creatine (Scr) and BUN in the PCNL group decreased after surgery, but only the change of BUN level had statistically significant(P=0.006). There was no statistically significant in the FURS group(P>0.05). Conclusions  Both percutaneous nephrolithotomy and flexible ureteroscopy are effective methods for 2.0-4.5 cm stones in a solitary kidney, PCNL has a higher rate of the stone-free rate than FURS, but FURS has less complications, and shorter postoperative hospital stay.