标准通道经皮肾镜取石术联合输尿管软镜钬激光碎石术治疗上尿路结石的疗效观察
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摘要
目的探讨标准通道经皮肾镜取石术(SPCNL)联合输尿管软镜钬激光碎石术(FURL)对上尿路结石患者结石清除率、肾功能指标及血液动力学的影响。方法上尿路结石患者108例,采用随机数字表法分为观察组和对照组各54例,对照组采用SPCNL术,观察组采用SPCNL术联合FURL术,记录两组手术一般情况、结石清除率、手术前后肾功能、血液动力学及并发症发生情况。结果观察组手术时间、结石清除率高于对照组,术后血红蛋白下降值、肾造瘘管留置时间、术后住院时间低于对照组(P <0. 05),两组住院费用比较差异无统计学意义(P> 0. 05);术后两组血清尿素(UA)、肌酐(Cr)、β2-微球蛋白(β2-MG)水平均上升(P <0. 05),组间比较差异无统计学意义(P> 0. 05);灌流后30 min两组平均动脉压(MAP)、中心静脉压(CVP)均上升(P <0. 05),组间各时点比较差异无统计学意义(P> 0. 05);两组术后并发症发生率比较,差异无统计学意义(P> 0. 05)。结论与SPCNL术相比,SPCNL联合FURL术治疗上尿路结石虽然会延长手术时间,但结石清除率更高,术后恢复快,且不会增加肾功能损伤,对血液动力学影响较小,值得临床推广应用。
Objective To investigate the effects of standard-channel percutaneous nephrolithotomy( SPCNL) combined with transurethral flexible ureteroscope holmium laser lithotripsy( FURL) on stone clearance rate,renal function indexes and hemodynamics in patients with upper urinary tract calculi.Methods One hundred and eight patients with upper urinary tract calculi were randomly divided into observation or control group,54 in each group.The control group was treated with SPCNL,and the observation group was given SPCNL combined with FURL.The general condition,stone clearance rate,renal function indexes such as urea( UA),creatinine( Cr)and β2-microglobulin( β2-MG) before and after operation,hemodynamic indexes such as mean arterial pressure( MAP),heart rate( HR),central venous pressure( CVP) and occurrence of complications were recorded in the two groups.Results The operative time and stone clearance rate in the observation group were longer and higher than those in the control group,but the hemoglobin decrease,indwelling time of renal fistula and postoperative hospital stay in the observation group were less and shorter than those in the control group( P < 0. 05).The difference in hospitalization expense was not statistically significant( P > 0. 05).The serum levels of UA,Cr andβ2-MG were increased after operation in the two groups( P < 0. 05),but there was no significant difference between the two groups( P> 0. 05).The MAP and CVP were increased in the two groups after 30 min of perfusion( P < 0. 05),but there was no significant difference in MAP,CVP and HR between the two groups at each time points( P > 0. 05).The incidence rate of postoperative complications in the observation group was slightly higher than that in the control group( 16. 67% vs.12. 96%) but not statistically significant( P >0. 05).Conclusion Compared with SPCNL alone,SPCNL combined with FURL for upper urinary tract calculi will prolong the operative time,but it has higher stone clearance rate and quicker postoperative recovery.It does not increase renal function damages,and has small effects on hemodynamics.Therefore it is worthy of clinical promotion and application.
Objective To investigate the effects of standard-channel percutaneous nephrolithotomy( SPCNL) combined with transurethral flexible ureteroscope holmium laser lithotripsy( FURL) on stone clearance rate,renal function indexes and hemodynamics in patients with upper urinary tract calculi.Methods One hundred and eight patients with upper urinary tract calculi were randomly divided into observation or control group,54 in each group.The control group was treated with SPCNL,and the observation group was given SPCNL combined with FURL.The general condition,stone clearance rate,renal function indexes such as urea( UA),creatinine( Cr)and β2-microglobulin( β2-MG) before and after operation,hemodynamic indexes such as mean arterial pressure( MAP),heart rate( HR),central venous pressure( CVP) and occurrence of complications were recorded in the two groups.Results The operative time and stone clearance rate in the observation group were longer and higher than those in the control group,but the hemoglobin decrease,indwelling time of renal fistula and postoperative hospital stay in the observation group were less and shorter than those in the control group( P < 0. 05).The difference in hospitalization expense was not statistically significant( P > 0. 05).The serum levels of UA,Cr andβ2-MG were increased after operation in the two groups( P < 0. 05),but there was no significant difference between the two groups( P> 0. 05).The MAP and CVP were increased in the two groups after 30 min of perfusion( P < 0. 05),but there was no significant difference in MAP,CVP and HR between the two groups at each time points( P > 0. 05).The incidence rate of postoperative complications in the observation group was slightly higher than that in the control group( 16. 67% vs.12. 96%) but not statistically significant( P >0. 05).Conclusion Compared with SPCNL alone,SPCNL combined with FURL for upper urinary tract calculi will prolong the operative time,but it has higher stone clearance rate and quicker postoperative recovery.It does not increase renal function damages,and has small effects on hemodynamics.Therefore it is worthy of clinical promotion and application.
引文
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[3]梁家正.Ⅰ期标准通道PCNL治疗上尿路结石疗效分析和结石残留因素分析[D].天津医科大学,2016.
[4]Zhong W,Leto G,Wang L,et al. Systermic inflammatory response syndrome after flexible ureteroscopic lithotripsy:a study of risk factors[J].J Endourol,2015,29(1):25-28.
[5]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.
[6]孙新来.内镜技术联合气压弹道碎石治疗尿路结石临床价值评述[J].标记免疫分析与临床,2016,29(9):1481-1483.
[7]Hyams ES,Monga M,Pearle MS,et al.A prospective,multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm[J].J Urol,2015,193(1):165-169.
[8]鄢羽中,周建辉,苏开德,等.经皮肾镜取石术与输尿管软碎石术治疗上尿路结石疗效的Meta分析[J].现代泌尿外科杂志,2016,21(8):617-622.
[9]De S,Autorino R,Kim FJ,et al.Percutaneous nephrolithotomy versus retrograde intrarenal surgery:a systematic review and meta-analys is[J].Eur Urol,2015,67(1):125-137.
[10]桂志明,苏劲,柳健军,等.输尿管软镜钬激光碎石术与经皮肾镜取石术治疗输尿管上段大结石的疗效比较[J].临床泌尿外科杂志,2017,32(1):61-64.
[11]陈杰,虞伟星,章更生,等.输尿管软镜联合钬激光治疗老年人上尿路结石的疗效分析[J].浙江医学,2016,38(13):1114-1115.
[12]郑健忠,梁福律,范先明,等.多通道经皮肾镜与单通道经皮肾镜联合输尿管软镜治疗复杂性肾结石的效果比较[J].现代泌尿外科杂志,2016,21(8):593-596.
[13]向宸辉,刘小勇,王鹏桥,等.单通道PCNL联合输尿管软镜治疗老年复杂性肾结石疗效观察[J].西南国防医药,2017,27(7):676-678.
[14]巴达仁贵,姜海山.B超引导下标准通道经皮肾镜取石术联合超声气压弹道碎石术治疗上尿路结石疗效研究[J].中国医学装备,2017,14(12):78-81.
[15]庞磊,邵晋凯,吕永安,等.顺行输尿管软镜钬激光碎石术联合B超定位单通道经皮肾镜治疗肾下盏憩室结石128例探讨[J].山西医药杂志,2015,44(17):2061-2062.
[2]KIM BS.Recent advancement or less invasive treatment of percutaneous nephrolithotomy[J].Korean J Urol,2015,56(9):614-623.
[3]梁家正.Ⅰ期标准通道PCNL治疗上尿路结石疗效分析和结石残留因素分析[D].天津医科大学,2016.
[4]Zhong W,Leto G,Wang L,et al. Systermic inflammatory response syndrome after flexible ureteroscopic lithotripsy:a study of risk factors[J].J Endourol,2015,29(1):25-28.
[5]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.
[6]孙新来.内镜技术联合气压弹道碎石治疗尿路结石临床价值评述[J].标记免疫分析与临床,2016,29(9):1481-1483.
[7]Hyams ES,Monga M,Pearle MS,et al.A prospective,multi-institutional study of flexible ureteroscopy for proximal ureteral stones smaller than 2 cm[J].J Urol,2015,193(1):165-169.
[8]鄢羽中,周建辉,苏开德,等.经皮肾镜取石术与输尿管软碎石术治疗上尿路结石疗效的Meta分析[J].现代泌尿外科杂志,2016,21(8):617-622.
[9]De S,Autorino R,Kim FJ,et al.Percutaneous nephrolithotomy versus retrograde intrarenal surgery:a systematic review and meta-analys is[J].Eur Urol,2015,67(1):125-137.
[10]桂志明,苏劲,柳健军,等.输尿管软镜钬激光碎石术与经皮肾镜取石术治疗输尿管上段大结石的疗效比较[J].临床泌尿外科杂志,2017,32(1):61-64.
[11]陈杰,虞伟星,章更生,等.输尿管软镜联合钬激光治疗老年人上尿路结石的疗效分析[J].浙江医学,2016,38(13):1114-1115.
[12]郑健忠,梁福律,范先明,等.多通道经皮肾镜与单通道经皮肾镜联合输尿管软镜治疗复杂性肾结石的效果比较[J].现代泌尿外科杂志,2016,21(8):593-596.
[13]向宸辉,刘小勇,王鹏桥,等.单通道PCNL联合输尿管软镜治疗老年复杂性肾结石疗效观察[J].西南国防医药,2017,27(7):676-678.
[14]巴达仁贵,姜海山.B超引导下标准通道经皮肾镜取石术联合超声气压弹道碎石术治疗上尿路结石疗效研究[J].中国医学装备,2017,14(12):78-81.
[15]庞磊,邵晋凯,吕永安,等.顺行输尿管软镜钬激光碎石术联合B超定位单通道经皮肾镜治疗肾下盏憩室结石128例探讨[J].山西医药杂志,2015,44(17):2061-2062.