无管化经皮肾镜取石术治疗对上尿路结石患者结石清除率、肾功能指标及血流动力学的影响
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摘要
目的探讨无管化经皮肾镜取石术(PCNL)治疗上尿路结石的疗效及安全性。方法 80例上尿路结石患者,按随机数字表法分为观察组与对照组各40例,观察组行无管化PCNL治疗,对照组行标准PCNL治疗。比较两组手术时间、结石清除率等指标,术前术后测定血肌酐(Scr)、尿素氮(BUN)等肾功能指标,并监测记录灌流前、灌流10 min、灌流60 min、术后心率(HR)、平均动脉压(MAP)水平。结果两组手术时间、术中出血量、血红蛋白下降值、结石清除率、Scr及BUN水平、术后并发症发生率比较,差异均无统计学意义(P>0.05);观察组术后3 h视觉模拟评分(VAS)、镇痛药物应用量、住院时间均少于对照组(P<0.05);两组灌流60 min、术后MAP水平高于灌流前(P<0.05)。结论无管化PNCL与标准PCNL结石清除率相当,均对上尿路结石患者肾功能、血流动力学无明显影响,但无管化PNCL在减轻术后疼痛、缩短住院时间上有明显优势。
Objective To explore the curative effect and safety of tubeless percutaneous nephrolithotomy( PCNL) in the treatment of upper urinary tract calculi.Methods Eighty patients with upper urinary tract calculi were divided into observation and control groups by using random number table method,40 cases in each group. The observation group was treated with tubeless PCNL and the control group was treated with standard PCNL.The operative time and stone clearance rate were compared between the two groups. The renal function indexes such as serum creatinine( Scr) and blood urea nitrogen( BUN) were determined before and after operation.The heart rate( HR) and mean arterial pressure( MAP) were monitored and recorded before perfusion and after 10 min and 60 min of perfusion.Results There was no significant difference in the operative time,intraoperative blood loss,decreased value of hemoglobin,stone clearance rate,levels of Scr and BUN and incidence of postoperative complications between the two groups( P > 0. 05).The visual analogue scale( VAS) score at 3 h after operation,the dosage of analgesic drugs and the length of hospital stay in the observation group were significantly lower/less/shorter than those in the control group( P < 0. 05).MAP at 60 min after perfusion and after operation was significantly higher than before perfusion in the both groups( P < 0. 05).Conclusion The stone clearance rate of tubeless PNCL is the same as that of standard PCNL.Both of the two operation modes have no significant effect on the renal function or hemodynamics in patients with upper urinary tract calculi.However,tubeless PNCL has more advantages in relieving the postoperative pain and shortening the hospital stay.
Objective To explore the curative effect and safety of tubeless percutaneous nephrolithotomy( PCNL) in the treatment of upper urinary tract calculi.Methods Eighty patients with upper urinary tract calculi were divided into observation and control groups by using random number table method,40 cases in each group. The observation group was treated with tubeless PCNL and the control group was treated with standard PCNL.The operative time and stone clearance rate were compared between the two groups. The renal function indexes such as serum creatinine( Scr) and blood urea nitrogen( BUN) were determined before and after operation.The heart rate( HR) and mean arterial pressure( MAP) were monitored and recorded before perfusion and after 10 min and 60 min of perfusion.Results There was no significant difference in the operative time,intraoperative blood loss,decreased value of hemoglobin,stone clearance rate,levels of Scr and BUN and incidence of postoperative complications between the two groups( P > 0. 05).The visual analogue scale( VAS) score at 3 h after operation,the dosage of analgesic drugs and the length of hospital stay in the observation group were significantly lower/less/shorter than those in the control group( P < 0. 05).MAP at 60 min after perfusion and after operation was significantly higher than before perfusion in the both groups( P < 0. 05).Conclusion The stone clearance rate of tubeless PNCL is the same as that of standard PCNL.Both of the two operation modes have no significant effect on the renal function or hemodynamics in patients with upper urinary tract calculi.However,tubeless PNCL has more advantages in relieving the postoperative pain and shortening the hospital stay.
引文
[1]高华廷,朱家红,刘洋洋,等.上尿路结石标准通道经皮肾镜碎石术部分无管化的临床探讨[J].国际泌尿系统杂志,2016,36(2):181-184.
[2]李清华,李波,马克,等.完全无管化微通道经皮肾镜取石术的临床疗效[J].安徽医学,2017,38(9):1187-1189.
[3]李雄,王晓隆,陈杰翔,等.国内无管化与标准化经皮肾镜取石术治疗上尿路结石的Meta分析[J].海南医学,2015,26(6):901-908.
[4]刘西社,李建华,张魁.微创经皮肾镜碎石取石术治疗肾结石疗效及对肾功能的影响[J].中国医师进修杂志,2013,36(11):31-34.
[5]廖松柏,于永刚,武英杰,等.微创经皮肾镜取石术对肾功能的影响[J].临床外科杂志,2011,19(7):486-487.
[6]Wickham JEA,Miller RA,Kellett MJ,et al.Percutaneous nephrolithotomy:One stage or tw[J].Br J Urology,1984,56(5):582-584.
[7]曾四平.部分无管化经皮肾镜治疗上尿路结石临床观察[J].重庆医学,2016,45(27):3836-3838.
[8]尚东梅,韩宇平.老年上尿路结石患者部分无管化与传统经皮肾镜碎石术的疗效对比[J].中国老年学杂志,2016,36(13):3269-3271.
[9]刘宏伟,左玲,柳建军,等.完全无管化经皮肾镜钬激光碎石术治疗上尿路结石42例[J].中国微创外科杂志,2016,16(6):511-513,517.
[10]de Cógáin MR,Krambeck AE.Advances in tubeless percutaneous nephrolithotomy and patient selection:an update[J].Curr Urol Reports,2013,14(2):136-137.
[11]Gonen M,Cicek T,Ozkardes H.Tubeless and stentless percutaneous nephrolithotomy in patients requiring supra-costal access[J].Urol Int,2009,82(4):440-443.
[12]Akman T,Binbay M,Yuruk E,et al.Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy:results of univariable and multivariable models[J].Urology,2011,77(2):299-304.
[13]彭境罗,姜庆.部分无管化与传统经皮肾镜取石术治疗上尿路结石的临床疗效对比[J].局解手术学杂志,2014,23(5):460-462
[14]肖强,黄忠.无管化经皮肾镜取石术治疗上尿路结石的疗效观察[J].浙江临床医学,2015,17(7):1106-1108.
[15]彭仁德,贺庆,廖邦华,等.输尿管软镜联合钬激光碎石治疗孤立肾与非孤立肾上尿路结石对照研究[J].实用医院临床杂志,2017,15(6):9-12.
[16]石国忠,李风,夏宗禹,等.微通道和标准通道经皮肾镜碎石术对上尿路结石患者血流动力学和血气分析的影响[J].中国全科医学,2015,18(2):215-218.
[2]李清华,李波,马克,等.完全无管化微通道经皮肾镜取石术的临床疗效[J].安徽医学,2017,38(9):1187-1189.
[3]李雄,王晓隆,陈杰翔,等.国内无管化与标准化经皮肾镜取石术治疗上尿路结石的Meta分析[J].海南医学,2015,26(6):901-908.
[4]刘西社,李建华,张魁.微创经皮肾镜碎石取石术治疗肾结石疗效及对肾功能的影响[J].中国医师进修杂志,2013,36(11):31-34.
[5]廖松柏,于永刚,武英杰,等.微创经皮肾镜取石术对肾功能的影响[J].临床外科杂志,2011,19(7):486-487.
[6]Wickham JEA,Miller RA,Kellett MJ,et al.Percutaneous nephrolithotomy:One stage or tw[J].Br J Urology,1984,56(5):582-584.
[7]曾四平.部分无管化经皮肾镜治疗上尿路结石临床观察[J].重庆医学,2016,45(27):3836-3838.
[8]尚东梅,韩宇平.老年上尿路结石患者部分无管化与传统经皮肾镜碎石术的疗效对比[J].中国老年学杂志,2016,36(13):3269-3271.
[9]刘宏伟,左玲,柳建军,等.完全无管化经皮肾镜钬激光碎石术治疗上尿路结石42例[J].中国微创外科杂志,2016,16(6):511-513,517.
[10]de Cógáin MR,Krambeck AE.Advances in tubeless percutaneous nephrolithotomy and patient selection:an update[J].Curr Urol Reports,2013,14(2):136-137.
[11]Gonen M,Cicek T,Ozkardes H.Tubeless and stentless percutaneous nephrolithotomy in patients requiring supra-costal access[J].Urol Int,2009,82(4):440-443.
[12]Akman T,Binbay M,Yuruk E,et al.Tubeless procedure is most important factor in reducing length of hospitalization after percutaneous nephrolithotomy:results of univariable and multivariable models[J].Urology,2011,77(2):299-304.
[13]彭境罗,姜庆.部分无管化与传统经皮肾镜取石术治疗上尿路结石的临床疗效对比[J].局解手术学杂志,2014,23(5):460-462
[14]肖强,黄忠.无管化经皮肾镜取石术治疗上尿路结石的疗效观察[J].浙江临床医学,2015,17(7):1106-1108.
[15]彭仁德,贺庆,廖邦华,等.输尿管软镜联合钬激光碎石治疗孤立肾与非孤立肾上尿路结石对照研究[J].实用医院临床杂志,2017,15(6):9-12.
[16]石国忠,李风,夏宗禹,等.微通道和标准通道经皮肾镜碎石术对上尿路结石患者血流动力学和血气分析的影响[J].中国全科医学,2015,18(2):215-218.