目的:比较一次性和可重复使用的数字输尿管软镜治疗下极结石的临床疗效和安全性。
方法:我们招募了135例患者接受了可重复使用的输尿管软镜(FURS),78例患者接受了一次性数字FURS。人口统计,临床变量,比较两组下花萼解剖参数及围手术期指标。
结果:36例漏斗角(IPA)<45°亚组患者接受了微型经皮肾镜取石术(mini-PCNL),包括可重复使用FURS组的25例患者和一次性使用FURS组的11例患者。两组FURS的人口统计学和临床变量具有可比性。取石成功率差异无统计学意义(P>0.05)。在碎石成功率方面,IPA≥45°亚组也无统计学差异(P>0.05),而在IPA<45°亚组中,单次使用FURS优于(χ2=6.513,P=0.011)。可重复使用的FURS和一次性使用的FURS组中的工作光纤的长度为3.20±0.68mm和1.75±0.47mm,t=18.297,P<0.05。在可重复使用的FURS中使用石篮(31/135,23.0%)显着高于单次使用的FURS(8/78,10.3%)(χ2=5.336,P=0.021)。与可重复使用的FURS组相比,一次性使用FURS组手术时间短(P<0.05),结石清除率(SFR)高(χ2=4.230,P=0.040)。两组术中微型PCNL转移及术后并发症比较差异无统计学意义(P>0.05)。
结论:一次性使用和可重复使用的FURS是清除下极结石的替代方法(即,2厘米或更小)。一次性使用FURS碎石成功率高,更短的操作时间,高无石率。
OBJECTIVE: To compare the clinical efficacy and safety of single-use and reusable digital flexible ureteroscopy for the treatment of lower pole stones.
METHODS: We enrolled 135 patients underwent reusable flexible ureteroscopy (FURS) and 78 patients underwent single-use digital FURS. Demographic, clinical variables, anatomical parameters of the lower calyx and perioperative indicators were compared in the two groups.
RESULTS: Thirty-six patients in the infundibuloureter angle (IPA) < 45° subgroup had a mini-percutaneous nephrolithotomy (mini-PCNL), including 25 patients in the reusable FURS group and 11 patients in the single-use FURS group. The demographic and clinical variables in the two FURS groups were comparable. There was no statistical difference in the success rate of stone searching (P > 0.05). In terms of the success rate of lithotripsy, there was also no statistical difference in the IPA ≥ 45° subgroup (P > 0.05), whereas single-use FURS was superior in the IPA < 45° subgroup (χ2 = 6.513, P = 0.011). The length of the working fiber in the reusable FURS and single-use FURS groups was 3.20 ± 0.68 mm and 1.75 ± 0.47 mm, respectively (t = 18.297, P < 0.05). The use of a stone basket in the reusable FURS (31/135, 23.0%) was significantly higher than that in the single-use FURS (8/78, 10.3%) (χ2 = 5.336, P = 0.021). Compared with the reusable FURS group, the single-use FURS group had shorter operation times (P < 0.05) and higher stone-free rate (SFR) (χ2 = 4.230, P = 0.040). There was no statistical difference in the intraoperative transfer of mini-PCNL and postoperative complications between the two groups (P > 0.05).
CONCLUSIONS: Single-use and reusable FURS are alternative methods for removal of lower pole stones (i.e., 2 cm or less). Single-use FURS has a high success rate of lithotripsy, shorter operation time, and high stone-free rate.