微创经皮肾镜取石术治疗老年复杂性肾结石的临床效果

Clinical Effect of Minimally Invasive Percutaneous Nephrolithotomy for Complicated Renal Calculi in the Elderly

目的探讨微创经皮肾镜取石术(mPCNL)治疗老年复杂性肾结石的临床效果。方法选取2016年1月至2017年11月在我院治疗的老年复杂性肾结石患者97例,采用随机数字表法将患者随机分为观察组(n=50)和对照组(n=47),观察组给予m PCNL治疗,对照组给予标准通道PCNL治疗,观察两组手术时间、术中出血量、结石一次性清除率等,同时检测手术前后血肌酐(Cr)、血尿素氮(BUN)及β_2-微球蛋白(BMG)水平。结果观察组手术时间为(130.41±18.11) min,长于对照组;而术中出血量为(108.41±30.22) m L,明显少于对照组,差异有统计学意义(P<0.05)。观察组结石一次清除率为88.00%,与对照组比较差异无统计学意义(P>0.05)。观察组尿液转清时间、造瘘管留置时间和住院时间分别为(40.25±3.41) h、(6.10±1.44) d和(8.44±1.71) d,明显短于对照组,差异有统计学意义(P<0.05)。观察组术后24h Cr、BUN和BGM分别为(94.46±10.65) mmol/L、(8.41±2.15) mmol/L和(2.11±0.87) ng/L,明显低于对照组,差异有统计学意义(P<0.05)。观察组术后24h视觉模拟评分法(VAS)评分为(2.41±0.89)分,明显低于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率为4.00%,明显低于对照组,差异有统计学意义(P<0.05)。结论 mPCNL治疗老年复杂性肾结石有较好的效果,对患者肾功能影响小,安全性较高。

Objective To explore the clinical effect of minimally invasive percutaneous nephrolithotomy(mPCNL)in the treatment of complicated renal calculi in the elderly.Methods 97 patients with complicated renal calculi treated in our hospital,from January 2016 to November 2017,were randomly divided into observation group(n=50)and control group(n=47)by random number table.The observation group was given mPCNL treatment,and the control group was given the standard channel PCNL treatment.The time of operation,the amount of bleeding in the operation,the disposable clearance rate of the stones were observed,and the levels of serum creatinine(Cr),blood urea nitrogen(BUN)and 2-globulin(BMG)were detected before and after operation.Results The operation time of the observation Group was(130.41±18.11)min,longer than the control group;and the intraoperative bleeding volume was(108.41±30.22)ml,significantly less than the control group,and the difference was statistically significant(P<0.05).In the observation group,the primary clearance rate was 88%,and compared with the control group,there was no significant difference(P>0.05).In the observation group,the urine transfer time,the fistula indwelling time and the hospitalization time were(40.25±3.41)h,(6.10±1.44)d and(8.44±1.71)d,obviously shorter than the control group,and the difference was statistically significant(P<0.05).24 hours after operation,the Cr,BUN and BGMin the observation group were(94.46±10.65)mol/L,(8.41±2.15)mmol/L and(2.11±0.87)ng/L,significantly lower than the control group,and the difference was statistically significant(P<0.05).24 hours after operation,the Visual analogue score(VAS)score was(2.41±0.89)in the observation group,significantly lower than that of the control group,and the difference was statistically significant(P<0.05).The incidence of postoperative complications was 4%,significantly lower than the control group,and the difference was statistically significant(P<0.05).Conclusion mPCNL has a good effect on the treatment of complicated renal calculi in the elderly,and has little effect on kidney function and high safety.