经皮微通道-微电子肾镜-微超声探针碎石术治疗1.5~2.5 cm肾结石的疗效和安全性

doi:10.19723/j.issn.1671-167X.2024.04.010

摘要/Abstract

摘要：

目的: 探讨经皮微通道-微电子肾镜-微超声探针碎石术(mini-track, mini-nephroscopy and mini-ultrasonic probe percutaneous nephrolithotomy, 3mPCNL)治疗1.5~2.5 cm肾结石的有效性和安全性。方法: 回顾性分析2023年11月至2024年1月共25例在北京大学人民医院行超声引导下3mPCNL的1.5~2.5 cm肾结石患者的围手术期资料和术后随访资料，匹配同时期内25例接受标准通道经皮肾镜碎石术(standard percutaneous nephrolithotomy, sPCNL)的1.5~2.5 cm肾结石患者，按照两组患者结石最大径差值的绝对值≤1 mm的标准进行一对一匹配，对比两种治疗方式的手术时间、肾功能改变情况、术后无石率、血红蛋白改变情况以及并发症率，进而初步分析3mPCNL治疗1.5~2.5 cm肾结石的有效性和安全性。结果: 3mPCNL组和sPCNL组患者在平均年龄、术前中位血肌酐、术前平均血红蛋白、术前平均红细胞压积、中位结石最大径和中位结石CT密度值之间的差异均无统计学意义，两组全部为单发结石。3mPCNL组患者的中位手术时间为60.0(45.0~110.0) min，与sPCNL组相比差异无统计学意义，全部为单通道手术。3mPCNL组术后平均血红蛋白为(115.3±15.5) mmol/L，与术前相比差异无统计学意义，平均血红蛋白降低值与sPCNL组相比差异无统计学意义[(9.5±2.2) mmol/L vs. (10.1±1.9) mmol/L]。3mPCNL组术后平均红细胞压积为(28.0±5.2)%，与术前相比差异有统计学意义(t=2.414，P=0.020)，平均红细胞压积降低值与sPCNL组相比差异无统计学意义(2.3% vs. 2.7%)。3mPCNL组术后中位血肌酐为74.0(51.0~118.0) μmol/L，与术前相比差异有统计学意义(Z=-2.980，P=0.005)。3mPCNL组和sPCNL组术后无石率分别为96.0%和97.3%，术后平均住院时间分别为(4.3±1.4) d和(5.5±2.0) d，差异有统计学意义(t=0.192, P=0.025)。1例sPCNL组患者拔除肾造瘘管后出现大量出血，行选择性肾动脉栓塞治疗后好转；1例3mPCNL组患者出现轻度肾周血肿，行保守治疗后好转，其余患者均未见并发症。结论: 3mPCNL治疗1.5~2.5 cm肾结石可以达到与sPCNL相当的有效率，可以在较短的手术时间内获得理想的术后无石率，且手术相关并发症率较低。

关键词: 肾结石, 微电子肾镜, 微超声探针, 泌尿外科手术

Abstract:

Objective: To investigate the efficacy and safety of mini-track, mini-nephroscopy and mini-ultrasonic probe percutaneous nephrolithotomy (3mPCNL) for the treatment of 1.5-2.5 cm kidney stones. Methods: The perioperative data and postoperative follow-up data of a total of 25 patients with about 1.5-2.5 cm kidney stones who underwent 3mPCNL under ultrasound guidance in Peking University People's Hospital from November 2023 to January 2024 were retrospectively analyzed. During the matching period, the 25 patients with 1.5-2.5 cm kidney stones receiving standard percutaneous nephrolithotomy (sPCNL) were matched one-to-one according to the criterion that the absolute difference of the maximum diameter of stones between the two groups was less than 1 mm. The operative time, renal function changes, postoperative stone-free rate, hemoglobin changes, and complication rate of the two treatments were compared, and then the effectiveness and safety of 3mPCNL were preliminarily analyzed. Results: There were no significant differences in mean age, preoperative median creatinine, preoperative mean hemoglobin, preoperative mean hematocrit, median stone maximum diameter, and median stone CT density between the 3mPCNL group and the sPCNL group. The median operation time in the 3mPCNL group was 60.0 (45.0-110.0) min, with no statistical significance compared with the sPCNL group, and all the patients underwent single-channel operations. The mean hemoglobin after operation in the 3mPCNL group was (115.3±15.5) mmol/L, and there was no significant difference between the preoperative group and the sPCNL group, and the mean hemoglobin decreased significantly between the sPCNL group and the sPCNL group [(9.5±2.2) mmol/L vs. (10.1±1.9) mmol/L]. The mean hematocrit after operation was (28.0±5.2)%, and the difference was statistically significant compared with that before operation (t=2.414, P=0.020). The mean hematocrit drop was not statistically signi-ficant compared with the sPCNL group (2.3% vs. 2.7%). The median serum creatinine in the 3mPCNL group was 74.0 (51.0-118.0) μmol/L after operation, and the difference was statistically significant compared with that before operation (Z=-2.980, P=0.005). The stone-free rate in the 3mPCNL group and the sPCNL group was 96.0% and 97.3%, respectively, and the mean hospital stay was (4.3± 1.4) d and (5.5±2.0) d, respectively, with the statistical significance (t=0.192, P=0.025). After the operation, one patient in sPCNL group had massive hemorrhage after the nephrostomy tube was removed, which was improved after selective renal artery embolization. One patient in the 3mPCNL group developed mild perirenal hematoma, which was improved after conservative treatment, and no complications were observed in the other patients. Conclusion: 3mPCNL in the treatment of 1.5-2.5 cm kidney stones can achieve an effective rate comparable to sPCNL, and can achieve the ideal stone-free rate in a shorter operative time with a lower rate of surgery-related complications.

Key words: Kidney calculi, Mini-nephroscopy, Mini-ultrasonic probe, Urologic surgical procedures

中图分类号:

R692.4

王明瑞,刘军,熊六林,于路平,胡浩,许克新,徐涛. 经皮微通道-微电子肾镜-微超声探针碎石术治疗1.5~2.5 cm肾结石的疗效和安全性[J]. 北京大学学报（医学版）, 2024, 56(4): 605-609.

Mingrui WANG,Jun LIU,Liulin XIONG,Luping YU,Hao HU,Kexin XU,Tao XU. Efficacy and safety of mini-track, mini-nephroscopy and mini-ultrasonic probe percutaneous nephrolithotomy for the treatment of 1.5-2.5 cm kidney stones[J]. Journal of Peking University (Health Sciences), 2024, 56(4): 605-609.

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参考文献 18

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Variables	3mPCNL group (n=25)	sPCNL group (n=25)	Statistics	P value
Age/years	53.5±9.8	53.1±10.5	t=0.139	0.890
Gender			χ²=0.081	0.777
Male	12 (48.0)	11 (44.0)
Female	13 (52.0)	14 (56.0)
Hypertension			χ²=0.095	0.758
Yes	7 (28.0)	8 (32.0)
No	18 (72.0)	17 (68.0)
Diabetes mellitus			χ²=0.085	0.771
Yes	10 (40.0)	9 (36.0)
No	15 (60.0)	16 (64.0)
Hyperuricemia			χ²=0.104	0.747
Yes	7 (28.0)	6 (24.0)
No	18 (72.0)	19 (76.0)
BMI/(kg/m²)	25.5±4.5	25.9±4.1	t=-0.329	0.744
Serum creatinine/(μmol/L)	78.5 (48.0-127.5)	80.0 (50.0-130.0)	Z=-0.177	0.860
Hemoglobin/(mg/dL)	125.0±19.5	126.4±21.0	t=-0.244	0.808
Hematocrit/%	31.0±3.4	30.0±3.6	t=1.010	0.318
Pyuria			χ²=0.222	0.637
Yes	3 (12.0)	2 (8.0)
No	22 (88.0)	23 (92.0)
Hydronephrosis			χ²=0.333	0.564
Yes	16 (64.0)	14 (56.0)
No	9 (36.0)	11 (44.0)
Stone laterality			χ²=1.282	0.258
Right	11 (44.0)	15 (60.0)
Left	14 (56.0)	10 (40.0)
Maxmium sone size/mm	2.2 (1.5-2.5)	2.0 (1.5-2.5)	Z=1.414	0.157
Stone CT value/Hu	1 020 (547-1 690)	1 147 (569-1 582)	Z=-1.496	0.135