【摘要】 目的比较孙氏镜、超细经皮肾镜取石术(super-mini-PCNL,SMP)及硕通镜碎石术处理上尿路结石的安全性与疗效。方法 2019年1～9月我院采用孙氏镜或SMP或硕通镜治疗1.0～2.0 cm输尿管上段或肾结石120例(每组40例),比较3组手术时间、一期碎石成功率、术中出血量、术后住院时间、疼痛程度、住院费用、手术并发症、术后3个月结石清除率。结果孙氏镜组手术时间(45.8±13.3)min,硕通镜组(50.1±12.8)min,明显短于SMP组(106.1±20.1)min(P<0.05)。SMP组一期碎石成功率97.5%,显著高于孙氏镜组77.5%和硕通镜组75.0%(P<0.05)。SMP组术后血红蛋白下降(14.2±6.4)g/L,显著高于孙氏镜组(4.1±2.3)g/L和硕通镜组(4.5±1.9)g/L(P<0.05)。SMP组住院时间(4.6±3.3)d,显著长于孙氏镜组(2.1±0.9)d和硕通镜组(2.5±1.1)d(P<0.05)。SMP组术后6 h疼痛VAS评分(4.1±1.7)分,显著高于孙氏镜组(2.1±0.7)分和硕通镜组(2.3±1.1)分(P<0.05)。孙氏镜组住院费用(1.1±0.4)万元,显著低于SMP组(1.8±1.3)万元和硕通镜组(1.6±0.5)万元(P<0.05)。术后3个月孙氏镜组结石清除率82.5%,SMP组97.5%,硕通镜组92.5%,3组比较差异无显著性(P>0.05)。孙氏镜组术后发热9例(22.5%),显著高于SMP组3例(7.5%)和硕通镜组1例(2.5%)(P<0.05)。SMP组肾周血肿发生率17.5%(7/40),与孙氏镜组7.5%(3/40)和硕通镜组5.0%(2/40)比较差异无显著性(P>0.05)。结论孙氏镜、SMP及硕通镜碎石术都是安全可靠的手术方式,孙氏镜、硕通镜更加微创,患者舒适度更好,住院时间更短,SMP在一期碎石成功率方面更有优势,但住院费用高、出血量多,3种术式可以成为互补,根据实际情况选择。更多还原

【Abstract】 Objective To compare the safety and efficacy of Sun’s ureterorenoscope, super-mini-PCNL(SMP) and Shuotong’s ureterorenoscope in the treatment of upper urinary tract calculi. Methods From January 2019 to September 2019, 120 patients with 1.0-2.0 cm upper ureteral or renal calculi were treated by Sun’s ureterorenoscope, SMP, or Shuotong’s ureterorenoscope in our hospital(40 cases per group). The differences of operation time, success rate of primary lithotripsy, bleeding volume, postoperative hospitalization time, pain degree, hospitalization cost, complications and stone removal rate in 3 months after operation were compared among the three groups. Results In terms of operation time, the Sun’s ureterorenoscope group [(45.8±13.3)min] and the Shuotong’s ureterorenoscope group [(50.1±12.8)min] had more advantages, which were significantly shorter than the SMP group [(106.1±20.1)min](P<0.05). In terms of the success rate of lithotripsy, the SMP group(97.5%) was significantly higher than the Sun’s ureterorenoscope group(77.5%) and the Shuotong’s ureterorenoscope group(75.0%,P<0.05). The bleeding in the SMP group(14.2±6.4)g/L was the highest, which was significantly higher than the Sun’s ureterorenoscope group [(4.1±2.3)g/L] and the Shuotong’s ureterorenoscope group [(4.5±1.9)g/L](P<0.05). The hospital stay in the SMP group [(4.6±3.3]d] was the longest, which was significantly longer than Sun’s ureterorenoscope group [(2.1±0.9)d] and Shuotong’s ureterorenoscope group [(2.5±1.1)d](P<0.05). The postoperative pain in the SMP group [(4.1±1.7)points] was more obvious, which was significantly higher than Sun’s ureterorenoscope group Group [(2.1±0.7)points] and Shuotong’s ureterorenoscope group [(2.3±1.1) points](P<0.05). The hospitalization expense in the Sun’s ureterorenoscope group [(1.1±0.4) thousand yuan] was the least, which was significantly lower than SMP group [1.8±1.3) thousand yuan] and Shuotong’s ureterorenoscope group [(1.6±0.5) thousand yuan](P<0.05). The stone clearance rates in 3 months after surgery were 82.5% in the Sun’s ureterorenoscope group, 97.5% in the SMP group, and 92.5% in the Shuotong’s ureterorenoscope group, without significant differences between the three groups(P>0.05). Postoperative fever was highest in the Sun’s ureterorenoscope group(9 cases, 22.5%), which was significantly higher than the SMP group(3 cases, 7.5%) and the Shuotong’s ureterorenoscope group(1 case, 2.5%)(P<0.05). The incidence of perirenal hematoma was higher in the SMP group(7 cases,17.5%), but there was no significant difference as compared with the Sun’s ureterorenoscope group(3 cases,7.5%) and the Shuotong’s ureterorenoscope group(2 cases,5.0%)(P>0.05). Conclusions Sun’s ureterorenoscope, SMP and Shuotong’s ureterorenoscope are all safe and reliable surgical methods. Sun’s ureterorenoscope and Shuotong’s ureterorenoscope are more minimally invasive, with better patient comfort and shorter hospital stay, while the SMP has an advantage in the success rate of primary lithotripsy, but has higher hospitalization cost and more bleeding volume. The three techniques can be complementary and should be selected according to the actual situations.更多还原