目的:比较穿刺针辅助内镜手术(NAES)和逆行肾内手术(RIRS)治疗1~2cm下极结石(LPS)的安全性和有效性。
方法:在2020年6月至2022年7月之间,对32例1至2-cmLPS和下极解剖结构不利的输尿管软镜患者进行了NAES治疗。使用配对分析(1:1情景)将这些患者的结局与接受RIRS的患者进行比较。匹配参数,如年龄,性别,身体质量指数,石头尺寸,硬度,和骨盆解剖特征,包括漏斗骨盆角,漏斗长度,并记录了宽度。使用学生t检验分析数据,Mann-WhitneyU测试,和费希尔的精确检验。
结果:两组具有相似的基线特征和下极解剖结构。两组之间的结石负担相当。NASE的初始无结石率(SFR)明显优于RIRS(87.5%vs62.5%,p=0.04)。NAES组和RIRS组的辅助率分别为12.5%和31.3%,分别(p=0.13)。最后,1个月随访后,NAES组的SFR仍高于RIRS组(93.8%对81.3%),但差异无统计学意义(p=0.26)。关于操作持续时间,总并发症发生率,以及术后住院时间,两组间无差异.
结论:与RIRS治疗1-至2-cm的LPS相比,在输尿管软镜检查中,NAES安全有效,SFR较高,并发症发生率相似。
OBJECTIVE: To compare the safety and efficacy of needle-perc-assisted endoscopic surgery (NAES) and retrograde intrarenal surgery (
RIRS) for the treatment of 1- to 2-cm lower-pole stones (LPS) in patients with complex infundibulopelvic anatomy.
METHODS: Between June 2020 and July 2022, 32 patients with 1- to 2-cm LPS and unfavorable lower-pole anatomy for flexible ureteroscopy were treated with NAES. The outcomes of these patients were compared with patients who underwent
RIRS using matched-pair analysis (1:1 scenario). The matching parameters such as age, gender, body mass index, stone size, hardness, and pelvicalyceal anatomy characteristics including infundibular pelvic angle, infundibular length, and width were recorded. Data were analyzed using the Student\'s t-test, Mann-Whitney U test, and Fisher\'s exact test.
RESULTS: The two groups had similar baseline characteristics and lower-pole anatomy. The stone burden was comparable between both groups. NASE achieved a significantly better initial stone-free rate (SFR) than
RIRS (87.5% vs 62.5%, p = 0.04). The auxiliary rates for the NAES and
RIRS groups were 12.5% and 31.3%, respectively (p = 0.13). Finally, the SFR after 1 month follow-up period was still higher for the NAES group than
RIRS group (93.8% versus 81.3%), but the difference was not statistically significant (p = 0.26). Concerning the operation duration, overall complication rates, and postoperative hospital stay, there were no differences between two groups.
CONCLUSIONS: Compared to RIRS for treating 1- to 2-cm LPS in patients with unfavorable infundibulopelvic anatomy for flexible ureteroscopy, NAES was safe and effective with higher SFR and similar complication rate.