PCNL联合RIRS治疗复杂性肾结石对清石率及并发症的影响

Effects of PCNL combined with RIRS on the stone clearance rate and complications in the treatment of complexrenal stones

目的探究经皮肾镜碎石取石术(PCNL)联合逆行输尿管软镜手术(RIRS)治疗复杂性肾结石对清石率及并发症的影响。方法回顾性分析2019年1月~2021年12月168例于我院行手术治疗的复杂性肾结石患者临床资料,根据手术方法的不同将其分为单镜组(PCNL治疗,81例)及联合组(PCNL联合RIRS治疗,87例)。比较两组结石清除率及术后并发症发生率,并检测患者手术前后肾功能、红细胞免疫功能指标及创伤应激指标水平。结果联合组结石清除率为96.55%(84/87),高于单镜组的86.42%(70/81)(P<0.05);联合组的手术时间长于单镜组(P<0.05);联合组术后NGAL、Scr及Cys-C水平均低于单镜组,C3bRR、ICRRR、TER及RBC-ICR值均大于单镜组,ACTH、Cor、sVCAM-1水平均低于单镜组(P<0.05);联合组并发症总发生率低于单镜组(P<0.05)。结论PCNL联合RIRS治疗复杂性肾结石,可提高结石清除率,减轻肾功能及红细胞免疫功能损伤,并能降低机体应激水平,减少术后并发症。

Objective:To investigate the effects of percutaneous nephrolithotomy(PCNL)combined with retrograde intrarenal surgery(RIRS)on the stone clearance rate and complications in treating complex renal stones.Methods:The clinical data of 168 patients with complex renal stones who underwent surgical treatment in the hospital were retrospectively analyzed between January 2019 and December 2021.According to the different surgical methods,the patients were divided into single nephroscope group(PCNL treatment,81 cases)and combined group(PCNL combined with RIRS treatment,87 cases).The stone clearance rates and incidence rates of postoperative complications were compared between the two groups,and the levels of renal function,red blood cell immune function indicators and trauma stress indicators were detected before and after surgery.Results:The stone clearance rate of combined group was 96.55%(84/87),which was higher than 86.42%(70/81)of single nephroscope group(P<0.05).The surgical time of combined group was longer than that of single nephroscope group(P<0.05).The levels of NGAL,Scr and Cys-C in combined group after surgery were lower,the C3bRR,ICRRR,TER and RBCICR were greater,and the levels of ACTH,Cor and sVCAM-1 were lower compared with those in single nephroscope(P<0.05).The total incidence rate of complications was lower in combined group than single nephroscope group(P<0.05).Conclusion:PCNL combined with RIRS in the treatment of complex renal stones can improve the stone clearance rate,relieve the injuries of renal function and red blood cell immune function,reduce the body’s stress level,and lower the postoperative complications.