斜仰卧截石位超微通道与微通道经皮肾镜分别联合输尿管软镜治疗直径≥2.5 cm肾结石效果比较

Comparison of the effects of ultramicro-channel and micro-channel percutaneous nephroscopy combined with flexible ureteroscopy in the treatment of kidney stones≥2.5 cm in diameter in the oblique supine lithotomy position

目的 探讨斜仰卧截石位超微通道与微通道经皮肾镜碎石术(PCNL)分别联合输尿管软镜治疗直径≥2.5 cm肾结石的疗效。方法 我院收治的肾结石患者96例,根据实施术式不同分为超微通道组和微通道组各48例。超微通道组采取斜仰卧截石位超微通道PCNL联合输尿管软镜,微通道组采用与超微通道组相同体位与术式下的微通道手术,术后3 d行泌尿系统CT检查评估结石清除率,并记录术中建立通道时间、碎石时间、全程手术时间及术后住院时间,术后24 h以疼痛视觉模拟评分表(VAS)评定两组疼痛程度,并比较两组手术前与手术后第1 d血清指标及术后并发症发生情况。结果 超微通道组与微通道组结石清除率比较,差异无统计学意义(P>0.05)。超微通道组建立通道时间及术后住院时间短于微通道组,但碎石时间和全程手术时间长于微通道组(P<0.05);超微通道组VAS评分低于微通道组(P<0.05)。术后,两组血肌酐(Scr)、C-反应蛋白(CRP)和降钙素原(PCT)水平升高,血红蛋白(Hb)水平降低(P<0.05),但两组间上述指标水平比较,差异无统计学意义(P>0.05)。两组并发症总发生率比较,差异无统计学意义(P>0.05)。结论 斜仰卧截石位超微通道与微通道PCNL联合输尿管软镜手术对直径≥2.5 cm肾结石的清除率相当,安全性好,前者建立通道时间短、术后恢复快、疼痛轻,后者碎石时间和全程手术时间更短。

Objective To investigate the efficacy of ultra-micro channel percutaneous nephrolithotripsy(PCNL)and microchannel PCNL combined with ureteroscope in the treatment of renal stones≥2.5 cm in diameter at the inclined supine lithotomy position.MethodsNinety-six patients with kidney stones in our hospital were selected.The patients were divided into an ultramicrochannel group and a micro-channel group according to dfferent operation methods,48 in each group.In the ultramicro-channel group,the ultramicroscopic channel PCNL combined with ureteroscope was used in the oblique supine lithotomy position.In the micro-channel group,the patients were treated with the same position and operation style as the ultramicro-channel group.Urinary CT examination was performed after 3 days of surgery to evaluate the stone clearance rate.The intraoperative time of channel establishment,lithotripsis time,whole operation time and postoperative hospitalization time were recorded.Visual analogue scale(VAS)was used to evaluate the pain degree of the two groups after 24 hours of surgery.The serum indexes before and after surgery as well as postoperative complications were compared between the two groups.Results There was no significant dfference in stone clearance between the two groups(P>0.05).The time of channel establishment and postoperative hospitalization time in the ultramicro-channel group was shorter than that in the micro-channel group,but the time of lithotripsis and total operation time in the ultramicro-channel group were longer than those in the micro-channel group(P<0.05).The VAS score of the ultramicro-channel group was lower than that of the microchannel group(P<0.05).After surgery,the levels of serum creatinine(Scr),C-reactive protein(CRP)and procalcitonin(PCT)were increased and the levels of hemoglobin(Hb)were decreased(P<0.05).However,there was no statistical difference in these indexes between the two groups(P>0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusions The clearance rate of kidney stones≥2.5 cm in diameter with ultramicro-channel and microchannel PCNL combined with ureteroscopic surgery is similar and safe.The former has shorter channel establishment time,faster postoperative recovery and less pain,while the latter has shorter lithotripsy time and full operation time.