【摘要】 目的比较微创经皮肾镜取石术(mPNL)及输尿管软镜取石术(f-URS)治疗老年病人直径1～2 cm肾结石的有效性及安全性。方法连续性选择2013年5月至2018年5月于北京京煤集团总医院泌尿外科直径为1～2 cm的老年肾结石病人122例,根据病人不同的手术方式分为mPNL组(n=43)和f-URS组(n=79),比较2组病人的一般资料及术后临床资料;以两种手术方法发生并发症风险进行回归分析,并绘制Kaplan-Meier曲线。结果直径为1～2 cm的老年肾结石病人总的结石清除率为89. 3%(109/122),术后并发症总的发生率为17. 2%(21/122)。相对于mPNL组,f-URS组的术后住院时间[(3. 5±1. 2) d比(4. 7±1. 6) d,P<0. 001]及总并发症发生率(10. 1%比30. 2%,P=0. 005)均显著降低,但结石清除率差异无统计学意义(P>0. 05);术后住院期间f-URS组总并发症的累积风险显著降低(P=0. 041)。结论以老年肾结石病人最终结石清除作为治疗有效,mPNL与fURS均能达到有效的治疗目标,但后者的术后并发症风险显著降低。更多还原

【Abstract】 Objective To evaluate and compare the efficacy and safety of flexible ureteroscopy(fURS) and mini-percutaneous nephrolithotomy (mPNL) for 1-2 cm renal stones in the elderly patients.Methods From May 2013 to May 2018,a total of 122 elderly patients with 1-2 cm renal stone were consecutively included in the study; 43 patients underwent mPNL and 79 cases underwent f-URS. The clinical data and postoperative data were compared between two groups. Regression analysis was used to evaluate the risk of complications after surgery. Results The total final stone-free rate was 89. 3%(109/122) in the elderly patients with 1-2 cm renal stone. The incidence rate of complications after surgery was 17. 2%(21/122). Compared with mPNL group,postoperative stay (3. 5 ± 1. 2 d vs 4. 7 ± 1. 6 d,P<0. 001) and the incidence rate of complications (10. 1% vs 30. 2%,P = 0. 005) were significantly decreased in f-URS group. There was no significant difference in final stone-free rate between the two groups (P>0. 05). Furthermore,f-URS group showed significantly lower cumulative risk of postoperative complications (P = 0. 041). Conclusions In the elderly patients with 1-2 cm kidney stone,f-URS and mPNL can achieve the same effective treatment goals. The risk of postoperative complications is significantly lower in f-URS group.更多还原