微创经皮肾镜与输尿管软硬镜联合治疗输尿管上段复杂结石的疗效对比

Comparison of the Curative Effect of Minimally Invasive Percutaneous Nephroscopy combined with Ureteroscopy in the treatment of Complicated Upper Ureteral Calculi

目的:比较微创经皮肾镜与输尿管软硬镜联合治疗输尿管上段复杂性结石的疗效。方法:选取本院2016年1月至2018年12月70例输尿管上段复杂性结石患者,随机分为对照组给予微创经皮肾镜治疗,研究组给予输尿管软硬镜联合治疗,两组各35例。比较两组患者围术期相关指标、结石清除率、手术前后血清炎症因子水平和术后并发症的发生情况等差异。结果:研究组术中出血量较对照组明显减少,手术时间较对照组明显延长,住院时间较对照组明显缩短(P<0.01)。研究组术后4周结石清除率(94.29%)较对照组(71.43%)明显升高(P<0.05);而两组患者术后12周结石清除率(100.00%比91.43%)的比较,并无明显差异(P>0.05)。两组患者术后1周血清C反应蛋白(CRP)和白细胞介素-6(IL-6)浓度较术前均明显升高,而研究组术后血清CRP和IL-6浓度较对照组明显降低(P<0.01)。两组患者术后发热、肾盂肾炎和腰痛发生率的比较,均无明显差异(P>0.05)。结论:相比微创经皮肾镜,输尿管软硬镜联合治疗可有效改善输尿管上段复杂性结石患者治疗效果,临床疗效显著,并且可缓解机体炎症反应,具有良好的有效性和安全性,因此值得临床应用。

Objective: To compare the curative effect of minimally invasive percutaneous nephroscope combined with ureteroscope for the treatment of complicated upper ureteral calculi. Methods: 70 patients with complicated upper ureteral calculi in our hospital from January 2016 to December 2018 were selected and randomly divided into the control group for minimally invasive percutaneous nephrolithotomy and the research group for combined ureteral soft and hard laparoscopy, with 35 cases in each group. The perioperative indicators, stone clearance rate, serum inflammatory factor level and postoperative complications were compared between the two groups. Results: The amount of blood loss in the study group was significantly reduced compared with the control group, the operation time was significantly prolonged compared with the control group, and the length of hospital stay was significantly shortened compared with the control group(P<0.01). The stone clearance rate(94.29%) in the study group was significantly higher than that in the control group(71.43%)(P<0.05). However, there was no significant difference in the stone clearance rate(100.00% vs. 91.43%) between the two groups at 12 weeks after surgery(P>0.05). Serum levels of C-reactive protein(CRP) and interleukin-6(IL-6) were significantly higher in the two groups one week after surgery than those before surgery, while serum levels of CRP and IL-6 in the study group were significantly lower than those in the control group(P<0.01). There was no significant difference in the incidence of postoperative fever, pyelonephritis and low back pain between the two groups(P>0.05). Conclusion: Compared with minimally invasive percutaneous nephroscopy, combined ureteroscopy with soft and hard ureteroscopy can effectively improve the treatment effect of patients with complicated upper ureteral calculi, with significant clinical efficacy, and can alleviate the inflammatory reaction of the body, with good efficacy and safety, so it is worthy of clinical application.