术前肾穿刺造瘘在输尿管软镜治疗老年肾结石患者中的应用

Application of preoperative nephrostomy in treatment of senile patients with renal calculi by flexible ureteroscope

目的探讨术前肾穿刺造瘘在输尿管软镜联合钬激光治疗老年肾结石患者的临床效果.方法收集2016年2月-2017年8月进行输尿管软镜碎石的老年肾结石患者80例,前瞻性随机对照研究,随机分成观察组与对照组,每组各40例,其中6例退出、3例失访,最终观察组35例,对照组36例.观察组于输尿管软镜钬激光碎石术前先在超声或CT引导下局麻行患侧肾穿刺造瘘,对照组则直接行输尿管软镜钬激光碎石,比较两组结石清除率、术后出血和感染等并发症情况以及住院时间,并检测术前、术毕以及术后24 h的C反应蛋白(CRP)量.结果所有患者手术均成功,观察组未出现大出血、高热等并发症,对照组术后有3例发热.观察组手术时间短于对照组,差异有统计学意义[(45.1±3.1)和(65.5±2.2)min,P<0.05],观察组术后1个月净石率高于对照组[94.3%(33/35)和77.8%(28/36)],术毕及术后24 h炎症指标均明显低于对照组,差异均有统计学意义(P<0.05).结论术前肾穿刺造瘘在输尿管软镜联合钬激光治疗老年患者肾结石中安全有效.

Objective To investigate the clinical effect of preoperative nephrostomy in treatment of senile patients with renal calculi with flexible ureteroscope and holmium laser. Methods From February 2016 to August 2017, 80 cases of elderly renal calculi with ureteroscopic lithotripsy were randomly divided into observation group and control group, 40 cases in each. The percutaneous nephrostomy was done which guided by ultrasound or CT guided before flexible ureteroscopic holmium laser lithotripsy in the observation group. In the control group, the flexible ureteroscopic holmium laser lithotripsy was performed directly. The postoperative bleeding and infection, the stone clearance rate, the C reaction protein and the length of hospital stay were evaluated. Results All the operations were successful, and no severe bleeding or hyperthermia occurred in the observation group. There were 3 cases of fever in the control group. Surgical duration was (45.1 ± 3.1) min for the observation group, which was lower than the observation group (65.5 ± 2.2) min, and the difference was statistically significant. The stone clearance rate at postoperative one month of the observation group was 94.3%(33/35), which was significantly lower than control group,which was 77.8%(28/36), and the C reaction protein at the end of operation and at 24 h postoperative were all lower than that of the control group, and the difference was statistically significant. Conclusion Preoperative nephrostomy was safe and effective in treatment of senile patients with renal calculi with flexible ureteroscope and holmium laser.