摘要:目的 比较组合式软性输尿管镜(FURS)和经皮肾镜(PCNL)治疗肾结石的有效性和安全性. 方法 选取我院2012年1月至2013年12月收治的肾结石患者207例.男120例,女87例.年龄21~65岁,平均38岁.根据患者或家属的选择分为FURS组108例和PCNL组99例.FURS组中,结石直径≥20 mm组33例,结石大小20~ 39 mm,平均(29.2±5.6) mm;<20 mm组75例,结石大小13~ 19 mm,平均(16.8±1.3) mm.PCNL组中,结石直径≥20 mm组51例,结石大小20~45 mm,平均(30.4±6.6) mm;<20 mm组48例,结石大小14~ 19 mm,平均(17.2±1.4) mm.组间比较差异无统计学意义(P>0.05).观察比较两种碎石方法的手术时间、清石率、术后住院时间及并发症发生情况等. 结果 FURS组和PCNL组的总清石率分别为80.6% (87/108)和91.9%(91/99),差异有统计学意义(P<0.05).结石直径<20 mm组中,FURS组和PCNL组的清石率分别为88.0%(66/75)和93.8%(45/48),差异无统计学意义(P>0.05);FURS组的手术时间为30~ 65 min,平均为(49.5±6.9) min,PCNL组为30~65 min,平均为(46.9±7.2) min,差异无统计学意义(P>0.05).结石直径≥20 mm组中,FURS组和PCNL组的清石率分别为63.6%(21/33)和90.2%(46/51),差异有统计学意义(P<0.05).FURS组手术时间为60~ 115 min,平均为(85.0±16.3) min,PCNL组为30~95 min,平均为(68.3±16.7) min,差异有统计学意义(P<0.05).FURS组并发症发生率[2.8% (3/108)]低于PCNL组[8.1%(8/99)],差异有统计学意义(P<0.05).FURS组术后住院时间为2~6d,平均为(3.5±1.4)d,PCNL组为3~9d,平均为(5.8±1.9)d,差异有统计学意义(P<0.05). 结论 FURS和PCNL均是治疗肾结石的有效方法.FURS具有微创、并发症发生率低、住院时间短等优点.FURS适合<20 mm的肾结石,对于≥20 mm的肾结石也有很好的疗效.%Objective To compare the safety and efficacy between flexible ureteroscope lithtripsy (FURL) and percutaneous nephrolithotomy (PCNL) in treating the renal calculus.Methods From Jan.2012 to Oct.2013,120 male and 87 female patients with renal calculus were accepted FURL (n =108)or PCNL (n=99) in our hospital.In FURL group,108 cases were classified according to the diameter of the stone,including 33 patients with the diameter of renal stone more than 20mm (range 20-39 mm,mean 29.2±5.6 mm)and 75 patients with the diameter of renal stone less than 20 mm (range 13-19 mm,mean 16.8± 1.3 mm).In PCNL group,99 cases were also classified according to the diameter of the stone,including 51 patients with the diameter of renal stone more than 20 mm (range 20-45 mm,mean 30.4±6.6 mm)and 48 patients with the diameter of renal stone less than 20 mm (range 14-19 mm,mean 17.2±1.4mm).There were no significant differences between the groups FURL and PCNL in the stone size(P>0.05).Demographic data,operative duration,postoperative hospital stay,complication rate,and stone-free rate were recorded and compared.Results The overall stone free rate in group FURL was significantly lower 80.6% (87/108) than that in group PCNL 91.9% (91/99) (P<0.05).In those patients with the diameter of stones less than 20 mm,the stone free rate was 88.0% (66/75) in group FURL vs 93.8% (45/48) in group PCNL (P>0.05).The operative time was 30-65 (mean 49.5±6.9) min and 30-65 (mean 46.9±7.2) min in FURL and PCNL group,respectively (P>0.05).In those patients with the diameter of stones more than 20 mm,the stone free rate was 63.6% (21/33) in group FURL,which was lower than that in group PCNL 90.2% (46/51) (P<0.05).The operative time was 60-115 min (85.0±16.3) min and 30-95 min (68.3± 16.7) min in FURL and PCNL group,respectively (P<0.05).The overall complication rate was significantly lower in group FURL 2.8% (3/108) compared to group PCNL 8.1% (8/99) (P<0.05).Postoperative hospitalization stay were 2-6 d (3.5±1.4) d and 3-9 d (5.8±1.9) d in FURL and PCNL group,respectively (P<0.05).Conclusions Both PCNL and FURS are efficacy and safe surgical alteration for patients with renal calculus.As to the FURS,its merits were faster recovery,less invasiveness than those in PCNL.Therefore,it can be considered as the first-line treatment for renal calculus <20 mm.However,for renal calculus ≥20 mm stones,FURS is still effective.