超微通道经皮肾镜与输尿管软镜碎石术联合治疗复杂性肾结石效果及对肾脏血流动力学、应激反应的影响

The effect of super mini percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy in the treatment of complex renal calculus and its effects on renal hemodynamics and stress response

目的:探讨超微通道经皮肾镜(SMP)与输尿管软镜碎石术(FURL)联合治疗复杂性肾结石效果及对肾脏血流动力学、应激反应的影响。方法:选取我院2019年1月至2021年8月225例复杂性肾结石患者,随机数字表法分为三组,各75例。A组采取SMP联合FURL治疗,B组采取SMP治疗,C组采取FURL治疗。比较三组取石效果、手术情况、术后恢复情况、手术前后肾脏血流动力学指标[肾脏段动脉舒张末期流速(Vmin)、收缩期峰值流速(Vmax)、阻力指数(RI)]、应激反应指标[血清皮质醇(Cor)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)]、性生活质量及并发症发生率。结果:相比B组和C组,A组手术时间长,结石清除率高,结石残留率低,差异具有统计学意义(P<0.05)。B组与C组结石清除率、结石残留率无明显差异(P>0.05)。A组和B组术中出血量、术后首次下床活动时间、住院时间高于C组,差异具有统计学意义(P<0.05)。相比术前,三组术后1 d肾脏段Vmin、Vmax低,A组、B组低于C组,RI以及术后1 d血清Cor、NE、ACTH水平,术后3个月患者对性生活满意度、患者配偶对性生活满意度评分高,A组、B组高于C组,差异具有统计学意义(P<0.05)。三组并发症发生率无明显差异(P>0.05)。结论:SMP与FURL联合治疗复杂性肾结石能显著提高结石清除率,减少结石残留,术后性生活质量改善较明显,且与SMP相比,不会增加对肾脏血流动力学、应激反应的影响及并发症风险。

Objective:To investigate the effect of super mini percutaneous nephrolithotomy(SMP)combined with flexible ureteroscopic lithotripsy(FURL)in the treatment of complex renal calculus and its effects on renal hemodynamics and stress response.Methods:A total of 225 patients with complicated renal calculus in our hospital from January 2019 to August 2021 were selected and divided into three groups according to the random number table method,with 75 cases in each group.GroupAwas treated with SMP combined with FURL,group B was treated with SMP,and group C was treated with FURL.The rate of stone removal,operation,postoperative,renal hemodynamic indicators[end-diastolic flow velocity(Vmin)of renal segmental artery,peak systolic flow velocity(Vmax),resistance index(RI)],stress reaction indicators[serum cortisol(Cor),norepinephrine(NE),adrenocorticotropic hormone(ACTH)]before and after operation,quality of sexual life and rate of complications were compared between the three groups.Results:Thestone removal rate of group A was higher than that of group B and C,and the stone residual rate was lower than that of group B and C(P<0.05).There were no significant defferences in the stone removal and residual rate between that of group B and C(P>0.05).Compared with group C,Groups A and B had higher intra-operative hemorrhagic volume,postoperative first off-bed time,and hospital staywith statistical significance(P<0.05).Compared with preoperative,the three groups had lower Vmin and Vmax postoperative 1d,group A and B was lower than that of group C,higher RI,serum Cor,NE,and ACTH postoperative1d,sexual life scoreof patient and spousepostoperative three months,group A and B were higher than that of group C with statistical significance(P<0.05).There was no significant differences in the rate of complications between the three groups(P>0.05).Conclusion:The combination of SMP and FURL for complex renal calculus significantly improves stone removal rate,reduces stone residual rate,and improves postoperative quality ofsexual life more significantly,and does not increase the impact on renal hemodynamics,stress response,or risk of complications compared with SMP.