经皮肾镜治疗肾结石合并肾盂输尿管连接部狭窄的临床效果分析

Analysis of clinical effect of percutaneous nephrolithotomy in the treatment of renal calculi and ureteropelvic junction stenosis

目的探讨经皮肾镜治疗肾结石合并肾盂输尿管连接部狭窄的正确操作和手术技巧,评价其临床效果。方法2016年6月至2018年6月宜宾市第二人民医院收治的50例肾结石合并肾盂输尿管连接狭窄患者,给予经皮肾镜手术治疗,记录结石清除率及不同严重程度患者手术结果、连接部狭窄改善率和并发症发生率;分别于术前和术后1周、1月、6月检测所有患者尿素氮(BUN)、肌酐Scr水平及肾盂集合系统分离指数,评估其肾功能。结果50例患者共54颗结石,结石清除率100%;50例轻、中度患者均一次取石成功,1例重度患者二次取石;手术时间40~65 min(47.16±6.13)min;住院时间6~13 d(12.30±5.21)d;肾盂输尿管连接部狭窄改善率94.00%(47/50)。轻、中、重度患者显效率及改善率差异有统计学意义(P<0.05);术前和术后1周、3月、6月BUN、Scr水平及肾盂集合系统分离指数差异有统计学意义(P<0.05);术后3、6月BUN、Scr水平及肾盂集合系统分离指数下降程度更显著(P<0.05);术中并发症发生率2.00%(1/50);术后并发症发生率6.00%(3/50)。结论肾结石合并肾盂输尿管连接部狭窄患者接受经皮肾镜手术治疗后疗效显著,且手术并发症发生少,值得临床推广。

Objective To investigate the correct operation and surgical techniques of percutaneous nephrolithotomy in the treatment of renal calculi with ureteropelvic junction stenosis,and to evaluate its clinical effect.Methods Fifty patients with renal calculi and ureteropelvic junction stenosis in our hospitals from June 2016 to June 2018 were selected,and all patients received the percutaneous nephrolithotomy.The stone clearance rate,surgical results,improvement rate of junction stenosis and incidence of complications in patients with different degrees were recorded.Levels of urea nitrogen(BUN)and creatinine and the separation index of renal pelvis collection system were measured to evaluate renal function in all patients before and after 1 week,one month and 6 months of surgery.Results There were 54 calculi in the 50 patients,and the calculi clearance rate was 100%.The stones of mild to moderate patients were successfully removed at first time,and 1 severe case underwent secondary stone removal.The operation time and hospitalization time were 40-65 min and with an average time of(47.16±6.13)min and(12.30±5.21)days,respectively.The improvement rate of ureteropelvic junction stenosis was 94.00%(47/50).There were statistically significant differences in the effect rate and the improvement rate of mild,moderate,and severe patients(P<0.05).There were significant differences in BUN,Scr levels and separation index of pyelonephric aggregation system before and after one week,one month and 6 months of surgery(P<0.05).BUN and Scr levels and separation index of pyelonephric aggregation system were decreased significantly at 3 and 6 months after operation(P<0.05).The incidence rates of intraoperative and postoperative complications were 2.00%(1/50)and 6.00%(3/50),respectively.Conclusion The application of percutaneous nephrolithotomy in the treatment of renal calculi with ureteropelvic junction stenosis has obtained significant effect,and the postoperative complications are fewer.It is worthy of clinical promotion.