Comparison of the effects of single-channel percutaneous nephrolithotomy combined with flexible ureteroscope and flexible ureteroscopic holmium laser lithotripsy in the treatment of complex kidney stones
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摘要:目的
比较单通道经皮肾镜取石术(PCNL)联合输尿管软镜与输尿管软镜钬激光碎石术治疗复杂性肾结石的效果。
方法选取101例复杂性肾结石患者作为研究对象，按照治疗方案的不同分为对照组49例与观察组52例。对照组采用输尿管软镜钬激光碎石术治疗，观察组采用单通道PCNL联合输尿管软镜治疗。比较2组患者手术情况、肾功能指标[中性粒细胞明胶酶相关载脂蛋白(NGAL)、胱抑素C (Cys-C)、血肌酐(Scr)]、应激指标[促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)、皮质醇(Cor)]、并发症情况与结石清除率。
结果观察组术后胃肠功能恢复时间、住院时间依次为(3.84±1.02)、(7.14±1.56) d, 分别短于对照组的(4.42±1.39)、(9.42±1.79) d, 差异有统计学意义(P < 0.05);观察组手术时间为(72.15±5.56) min, 长于对照组的(69.08±6.01) min, 差异有统计学意义(P < 0.05)。术后, 2组NGAL、Cys-C、Scr、ACTH、NE、Cor水平均高于术前，但观察组NGAL、Cys-C、Scr、ACTH、NE、Cor水平均低于对照组，差异有统计学意义(P < 0.05)。对照组、观察组并发症总发生率分别为10.20%、3.85%, 差异无统计学意义(P>0.05);观察组结石清除率为100.00%, 高于对照组的87.76%, 差异有统计学意义(P < 0.05)。
结论与输尿管软镜钬激光碎石术相比，单通道PCNL联合输尿管软镜对复杂性肾结石的清除率更高，患者术后胃肠功能恢复更快，肾功能损伤程度和应激反应更轻，从而可尽早出院，但手术时间更长。
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关键词:
- 单通道经皮肾镜取石术 /
- 输尿管软镜 /
- 输尿管软镜钬激光碎石术 /
- 复杂性肾结石
Abstract:ObjectiveTo compare the effects of single-channel percutaneous nephrolithotomy (PCNL) combined with flexible ureteroscope with flexible ureteroscopic holmium laser lithotripsy in the treatment of complex kidney stones.
MethodsA total of 101 patients with complicated kidney stones were selected as study objects, and were divided into two groups according to different treatment plans. The control group (n=49) received flexible ureteroscopic holmium laser lithotripsy, and the observation group (n=52) received single-channel PCNL combined with flexible ureteroscope treatment. The operation conditions, renal function [neutrophil gelatinase-associated apolipoprotein (NGAL), cystatin C (Cys-C), and blood creatinine (Scr)], stress indicators [adrenocorticotropic hormone (ACTH), norepinephrine (NE), and cortisol (Cor)], complications and stone clearance rate were compared.
ResultsThe recovery time of gastrointestinal function and hospital stay in the observation group was (3.84±1.02)d, (7.14±1.56) d, which were shorter than(4.42±1.39) d, (9.42±1.79)d of the control group (P < 0.05); the operation time in the observation group was (72.15±5.56) min, which was longer than (69.08±6.01) min in the control group (P < 0.05). The NGAL, Cys-C, Scr, ACTH, NE, and Cor in the two groups after operation were higher than those before operation, and NGAL, Cys-C, Scr, ACTH, NE, and Cor in the observation group were lower than those in the control group (P < 0.05). The total incidence of complications in control group and observation group were 10.20% and 3.85%, respectively, but no significant difference was found (P>0.05). The stone clearance rate in the observation group was 100.00%, which was higher than 87.76% in the control group, and the difference was statistically significant (P < 0.05).
ConclusionCompared with flexible ureteroscopic holmium laser lithotripsy, single-channel PCNL combined with flexible ureteroscope for patients with complex kidney stones has higher stone clearance rate, shorter postoperative gastrointestinal function recovery time, less damage to kidney function, and small stress response, and can make the patients discharge as soon as possible, but it has longer operation time.
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表 1 2组患者一般资料比较(x±s)[n(%)]
组别 n 年龄/岁 性别 结石部位 结石直径/cm 结石类型 男 女 左 右 鹿角形结石 部分鹿角形结石 多发性结石 对照组 49 54.56±10.24 28(57.14) 21(42.86) 26(53.06) 23(46.94) 3.23±0.58 11(22.45) 25(51.02) 13(26.53) 观察组 52 53.84±10.13 32(61.54) 20(38.46) 33(63.46) 19(36.54) 3.31±0.62 10(19.23) 27(51.92) 15(28.85) 
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表 2 2组患者手术情况比较(x±s)
组别 n 术后胃肠功能恢复时间/d 手术时间/min 住院时间/d 对照组 49 4.42±1.39 69.08±6.01 9.42±1.79 观察组 52 3.84±1.02* 72.15±5.56* 7.14±1.56* 与对照组比较, *P < 0.05。
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表 3 2组患者肾功能指标比较(x±s)
组别 时点 NGAL/(μg/L) Cys-C/(μg/L) Scr/(μmol/L) 对照组(n=49) 术前 3.53±0.63 510.95±31.56 60.43±7.16 术后 5.42±0.55* 786.23±36.28* 75.55±8.32* 观察组(n=52) 术前 3.47±0.72 514.14±31.43 59.56±7.23 术后 4.63±0.46*# 600.02±32.45*# 70.27±8.08*# NGAL: 中性粒细胞明胶酶相关载脂蛋白; Cys-C: 胱抑素C; Scr: 血肌酐。与术前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 4 2组患者应激指标比较(x±s)
组别 时点 ACTH/(ng/L) NE/(ng/mL) Cor/(nmol/L) 对照组(n=49) 术前 25.72±3.58 210.43±24.43 97.18±15.64 术后 54.17±6.14* 306.38±30.16* 177.76±22.45* 观察组(n=52) 术前 24.99±3.83 208.72±23.01 100.25±14.98 术后 35.77±4.62*# 244.33±27.25*# 123.38±18.34*# ACTH: 促肾上腺皮质激素; NE: 去甲肾上腺素; Cor: 皮质醇。与术前比较, *P < 0.05; 与对照组比较, #P < 0.05。
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表 5 2组患者并发症情况与结石清除情况比较[n(%)]
组别 n 并发症 结石清除 出血 尿瘘 感染 合计 对照组 49 2(4.08) 2(4.08) 1(2.04) 5(10.20) 43(87.76) 观察组 52 1(1.92) 0 1(1.92) 2(3.85) 52(100.00)* 与对照组比较, *P < 0.05。
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