同期双侧逆行肾内输尿管软镜碎石治疗老年双侧肾结石的临床疗效

Clinical Efficacy of Simultaneous Bilateral Retrograde Intrarenal Surgery in the Treatment of Elderly Bilateral Kidney Stones

目的 探讨同期双侧逆行肾内输尿管软镜碎石(retrograde intrarenal surgery,RIRS)治疗老年双侧肾结石的临床效果。方法 回顾性分析作者医院2018-06/2021-05月收治的58例老年双侧肾结石患者的临床资料。根据是同期还是分期行RIRS完成双侧肾结石手术分为同期组(n=26)和分期组(n=32)。比较两组患者的临床基线资料;分析术后结石清除率和相关并发症;使用国际肾脏基金会的慢性肾脏病(chronic kidney disease,CKD)分期标准,通过计算肾小球滤过率(estimated glomerular filtration rate,eGFR)评估术后肾功能变化。结果 两组患者的性别、年龄、体质量指数(body mass index,BMI)、合并症方面差异均无统计学意义(P均>0.05)。两组患者的结石长径、结石横径、结石表面积、结石CT值、尿酸水平、一期结石清除率、行体外冲击波碎石术补救率、并发症、住院天数比较,差异均无统计学意义(P均>0.05)。同期组术后CKD2期、3b期人数少于术前,但差异均无统计学意义(P均>0.05)。所有患者均未出现严重的肾功能不全。同期组术后血肌酐较术前明显下降(P<0.05),两组患者手术前后C反应蛋白、eGFR水平比较差异均无统计学意义(P均>0.05)。结论 同期双侧RIRS治疗老年双侧肾结石患者是安全、有效的,具有临床应用价值。

Objective To investigate the clinical efficacy of simultaneous bilateral retrograde intrarenal surgery(RIRS) in the treatment of elderly bilateral kidney stones.Methods Clinical data of 58 elderly patients with bilateral kidney stones admitted to author′s hospital from June 2018 to May 2021 were retrospective analyzed.According to whether bilateral kidney stone surgery was completed with RIRS during the same period or by stages,the patients were divided into synchronous group(n=26) and staging group(n=32).The clinical baseline data of two groups of patients were compared;the postoperative stone free rate and related complications were analyzed;International Kidney Foundation′s chronic kidney disease(CKD) staging criteria was used,and the postoperative renal function change was calculated by the estimated glomerular filtration rate(eGFR).Results There were no significant differences in gender,age,body mass index(BMI) and complications of patients between the two groups(all P>0.05).There were no significant differences in stone length,stone transverse diameter,stone surface area,stone CT value,uric acid level,one-stage stone clearance rate,rescue rate of extracorporeal shock wave lithotripsy,complication and length of hospital stay of patients between the two groups(all P>0.05).The number of CKD 3b stage of patients after surgery was significantly lower than before,but the difference was not statistically significant(all P>0.05).All patients did not experience severe renal dysfunction.The serum creatinine in synchronous group significantly decreased after surgery(P<0.05),there were no significant differences in the levels of C-reactive protein and eGFR between the two groups before and after surgery(all P>0.05).Conclusion Simultaneous bilateral RIRS is a safe and effective treatment method for elderly patients with bilateral kidney stones,and has clinical application value.