李群秀, 张胜利, 邢伟只, 李磊. 经皮肾微造瘘取石术联合输尿管软镜碎石术治疗上尿路结石患者的疗效观察[J]. 实用临床医药杂志, 2024, 28(10): 42-45. DOI: 10.7619/jcmp.20240065
引用本文: 李群秀, 张胜利, 邢伟只, 李磊. 经皮肾微造瘘取石术联合输尿管软镜碎石术治疗上尿路结石患者的疗效观察[J]. 实用临床医药杂志, 2024, 28(10): 42-45. DOI: 10.7619/jcmp.20240065
LI Qunxiu, ZHANG Shengli, XING Weizhi, LI Lei. Effect of minimally invasive percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy in treatment of patients with upper urinary tract calculi[J]. Journal of Clinical Medicine in Practice, 2024, 28(10): 42-45. DOI: 10.7619/jcmp.20240065
Citation: LI Qunxiu, ZHANG Shengli, XING Weizhi, LI Lei. Effect of minimally invasive percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy in treatment of patients with upper urinary tract calculi[J]. Journal of Clinical Medicine in Practice, 2024, 28(10): 42-45. DOI: 10.7619/jcmp.20240065

经皮肾微造瘘取石术联合输尿管软镜碎石术治疗上尿路结石患者的疗效观察

Effect of minimally invasive percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy in treatment of patients with upper urinary tract calculi

  • 摘要:
    目的 观察经皮肾微造瘘取石术(MPCNL)联合输尿管软镜碎石术(FURSL)治疗上尿路结石的疗效。
    方法 将92例上尿路结石患者随机分为2组,每组46例。对照组采用MPCNL治疗,研究组采用MPCNL联合FURSL治疗。比较2组结石清除率、手术时间、住院时间、治疗费用、肾功能指标、血流动力学指标、氧化应激因子水平及并发症发生情况。
    结果 研究组结石清除率、治疗费用、手术时间高于、长于对照组,住院时间短于对照组,差异均有统计学意义(P<0.05)。术后24 h, 2组血尿素氮、血肌酐、β2-微球蛋白水平均高于同组术前,差异有统计学意义(P<0.05)。术毕时, 2组中心静脉压、平均动脉压、心率比较,差异无统计学意义(P>0.05)。术后24 h, 2组血红素氧合酶-1、内皮素-1、皮质醇、促血管生成素Ⅱ水平均高于同组术前,但研究组血红素氧合酶-1、内皮素-1、皮质醇、促血管生成素Ⅱ水平低于对照组,差异均有统计学意义(P<0.05)。研究组并发症总发生率为28.26%, 对照组为23.91%, 差异无统计学意义(P>0.05)。
    结论 MPCNL联合FURSL会延长手术时间,增加治疗费用,但能提高上尿路结石的结石清除率,缩短住院时间,对血流动力学、氧化应激因子的影响较小,且未加重肾功能损伤及增高术后并发症发生率。

     

    Abstract:
    Objective To observe the effect of minimally invasive percutaneous nephrolithotomy (MPCNL) combined with flexible ureteroscopic lithotripsy (FURSL) in treating upper urinary tract calculi.
    Methods A total of 92 patients with upper urinary tract calculi were randomly divided into two groups, with 46 cases in each group. Control group was treated with MPCNL, while study group was treated with MPCNL and FURSL. Stone clearance rate, operation time, hospital stay, therapeutic costs, renal function indexes, hemodynamics, levels of oxidative stress factors, and incidence of complications were compared between two groups.
    Results The stone clearance rate, operation time and therapeutic costs of the study group were significantly higher and longer than those of the control group, while the hospital stay was significantly shorter than that of the control group (P < 0.05). At 24 hours after operation, the levels of blood urea nitrogen, serum creatinine and β2-microglobulin in both groups were significantly higher than those before surgery (P < 0.05). There were no significant differences in central venous pressure, mean arterial pressure and heart rate at the end of operation between the two groups (P > 0.05). At 24 hours after operation, the levels of hemeoxygenase-1, endothelin-1, cortisol and angiopoietin Ⅱ in both groups were significantly higher than those before surgery, while the levels of hemeoxygenase-1, endothelin-1, cortisol and angiopoietin Ⅱ in the study group were significantly lower than those in the control group (P < 0.05). The total incidence of complications was 28.26% in the study group, which showed no significant difference compared to 23.91% in the control group (P > 0.05).
    Conclusion MPCNL combined with FURSL can prolong the operation time and increase therapeutic costs, but also can increase the stone clearance rate of upper urinary tract calculi, shorten hospital stay, exert little impacts on hemodynamics and oxidative stress factors, and do not exacerbate renal function damage or increase postoperative incidence of complications.

     

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