经皮肾镜联合输尿管软镜治疗孤立肾合并复杂性结石的临床疗效及对患者肾功能的影响

The clinical effects of percutaneous nephrolithotomy combined with flexible ureteroscope in the treatment of solitary kidney and complicated stones and its effect on renal function

目的分析一期经皮肾镜取石术联合二期输尿管软镜碎石术治疗孤立肾合并复杂性结石的临床疗效及对患者肾功能的影响。方法我院接受治疗的106例孤立肾合并复杂性结石患者,根据治疗方式不同分为研究组与对照组各53例。对照组单纯采用经皮肾镜取石术治疗,研究组在对照组基础上联合输尿管软镜碎石术治疗,观察两组临床疗效、术中相关指标及术后并发症发生率、结石清除率,同时对比肾功能指标的变化。结果研究组术中出血量、术中血红蛋白下降水平、住院时间及术后复发、感染、大出血发生率均低于对照组,手术时间高于对照组(P<0.05)。研究组结石清除率及临床总有效率高于对照组(P<0.05)。治疗后,两组血清尿素氮(BUN)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平均高于治疗前,血清肌酐(Scr)水平低于治疗前,且研究组血清BUN、NGAL水平高于对照组,血清Scr水平低于对照组(P<0.05)。结论采用经皮肾镜取石术联合输尿管软镜碎石术对孤立肾合并复杂性结石患者进行治疗可以获得良好疗效,可明显提高结石清除率,减少出血并发症,保留残余肾功能,明显缩短恢复时间。

Objective To analyze the clinical efficacy of the first-stage percutaneous nephrolithotomy combined with the second-stage flexible ureteroscope in the treatment of solitary kidney and complicated stones and its effect on renal function.Methods The clinical data of 106 patients with isolated kidney and complicated stones were retrospectively studied.The selected patients were divided into study group and control group according to different treatment methods,53 in each group.The patients in the control group were treated with percutaneous nephrolithotomy alone.The patients in the study group were treated with flexible ureteroscope on the basis of the control group.The clinical efficacy,intraoperative related indicators,postoperative complication rate,stone removal rate,and changes in renal function were compared between the two groups.Results The intraoperative blood loss,intraoperative hemoglobin decline level,and hospital stay after treatment as well as the incidence of postoperative recurrence,postoperative infection,and postoperative major hemorrhage were significantly lower or shorter in the study group than those in the control group(P<0.05).The operation time of the study group was significantly longer than that of the control group(P<0.05).After treatment,the stone removal rate and total efficiency of the study group was significantly higher than that of the control group(P<0.05).After treatment,the serum BUN and NGAL levels were significantly higher and the serum Scr level was significantly lower than those before treatment in the two groups(P<0.05).The serum BUN and NGAL levels were significantly higher and serum Scr levels was significantly lower in the study group than those of the control group(P<0.05).Conclusion Percutaneous nephrolithotomy combined with flexible ureteroscope can improve the curative effect of patients with isolated kidney and complicated stones.It can significantly improve the stone clearance rate,reduce the bleeding complications,retain the residual renal function,and significantly shorten the recovery time.