不同手术方式治疗男性复杂性肾结石的疗效和对患者性功能影响的比较

Comparison of the efficacy and sexual function of different surgical methods on male complicated renal calculi

目的比较经皮肾镜碎石(PCNL)和开放式手术(OP)治疗复杂性肾结石的疗效和对患者性功能、生存质量和抑郁焦虑情绪的影响。方法选取我院2015年3月至2016年10月收治的109例复杂性肾结石患者,随机行PCNL治疗(68例)和OP治疗(41例)。对比两组患者手术时间、术中出血量、一期手术结石取净率和术中并发症的发生率,术后住院时间、住院费用、出院时结石清除率和术后并发症的发生率。在术后3个月和6个月时,检测患者血肌酐水平、性功能和情绪变化。结果 PCNL组患者的手术时间、术中出血量和术中并发症均低于OP组,差异具有统计学意义(P <0.05)。PCNL组患者的住院时间明显少于OP组,住院花费和出院时结石完全清除率高于OP组患者,差异具有统计学意义(P <0.05)。术后第3个月和第6个月,PCNL组患者血肌酐明显低于OP组,差异具有统计学意义(P <0.05)。术后6个月时PCNL患者IIEF-5评分和PEDT评分明显低与OP组,CIPE评分在术后第3和第6个月时明显高于OP组,差异亦具有统计学意义(P <0.05)。术后第3个月时,PCNL组患者躯体疼痛评分低于OP组,社会功能评分和健康评分高于OP组,差异具有统计学意义(P <0.05)。结论 PCNL手术治疗复杂性肾结石效果优于OP,是复杂性肾结石较理想的治疗手段之一。

Objective To compare the effects of percutaneous nephrolithotomy(PCNL)and open surgery(OP)on patients with complex renal calculi and on sexual function,quality of life and depression and anxiety.Methods One hundred and nine patients with complicated renal calculi admitted in our hospital from March 2015 to October 2016 were selected and randomly treated with PCNL(68 cases)and OP treatment(41 cases).The inci-dence of intraoperative bleeding,the cost of hospitalization,the removal rate of calculus and postoperative compli-cations were compared between the two groups.The level of serum creatinine was measured at 3 months and 6 months.The International Elderly Function Rating Scale(IIEF-5),the Chinese Patients with Premature Elderly Patients(CIPE)and the Premature Erection Diagnostic Tool Scale(PEDT)were used to evaluate the sexual func-tion of patients.The quality of life was assessed using the Health Survey(SF-36)method.Hamilton Depression Scale(HAMD)and Hamilton Anxiety Scale(HAMA)were used to evaluate depression and anxiety in patients.Results The operation time,intraoperative blood loss and intraoperative complications were significantly lower in the PCNL group than those in the OP group.There was no significant difference between the two groups in the removal rate(P>0.05).The hospitalization time of PCNL group was significantly less than that in OP group.The complete clearance rate of hospitalization and hospital discharge were higher than those in OP group.The serum creatinine in PCNL group was significantly lower than that in OP group at 3 months and 6 months after operation(P<0.05).The scores of IIEF-5 and PEDT were significantly lower in PCNL patients than those in OP group at 6 months after operation(P<0.05).At the third month after operation,the body pain score of PCNL group was lower than that in OP group,the social function score and health score were higher than those in OP group(P<0.05,respectively).In the third month after operation,the HAMA score in the PCNL group was lower than that in OP group(P<0.05).Conclusion PCNL is superior to OP in the treatment of complex renal calculus,and intraoper-ative,postoperative complications,stone clearance rate,postoperative renal function,sexual function recovery,as well as the quality of life and anxiety improvement,which is one of the ideal treatments for complex kidney stones.