单通道微创经皮肾镜碎石取石术与多通道微创经皮肾镜碎石取石术治疗对上尿路结石患者的影响

Effect of single-channel minimally invasive percutaneous nephrolithotomy and multi-channel minimally invasive percutaneous nephrolithotomy on patients with upper urinary calculi

目的探讨单通道微创经皮肾镜碎石取石术(MPCNL)与多通道MPCNL治疗对上尿路结石患者的影响。方法选取2015年6月至2019年9月蒙阴县人民医院泌尿外科收治的230例上尿路结石的患者,男125例,女105例,年龄(41.20±0.32)岁,年龄范围为20~71岁,根据手术方式将患者分为单通道组(n=112)与多通道组(n=118),观察并比较两组患者的治疗效果、围术期指标、肾功能及并发症。结果两组患者的术中出血量及尿液转清时间比较,差异无统计学意义(P>0.05)。多通道组患者的手术时间及术后住院时间[(84.25±11.26)min、(13.68±2.27)d]均短于单通道组[(101.35±12.34)min、(16.44±3.21)d],差异有统计学意义(P<0.05)。多通道组患者结石一次性清除率与单通道组比较,差异无统计学意义(P>0.05)。术前两组患者的各项指标比较,差异无统计学意义(P>0.05)。术后,单通道组与多通道组血肌酐[(126.37±21.07)μmol/L、(121.58±22.35)μmol/L],尿素氮[(6.71±1.32)mmol/L、(6.44±1.38)mmol/L],尿酸[(272.66±22.24)μmol/L、(268.25±24.14)μmol/L],血红蛋白水平[(114.58±12.58)g/L、(112.16±11.05)g/L]均低于术前[(164.39±24.25)μmol/L、(166.05±23.27)μmol/L,(18.24±3.24)mmol/L、(18.39±3.35)mmol/L,(521.25±37.58)μmol/L、(526.35±36.57)μmol/L,(128.36±13.25)g/L、(127.68±14.35)g/L],尿量[(1354.36±54.58)ml/24 h、(1387.88±53.69)ml/24 h]高于术前[(325.25±34.51)ml/24 h、(331.05±35.08)ml/24 h],差异有统计学意义(P<0.05),且术后多通道组患者术后尿量[(1387.88±53.69)ml/24 h]高于单通道组[(1354.36±54.58)ml/24 h],差异有统计学意义(P<0.05)。多通道组患者术后大出血、术后发热及伤口愈合不良的并发症发生率与单通道组比较,差异无统计学意义(P>0.05)。结论单通道MPCNL在清除多数上尿路结石中具有良好的治疗效果,与单通道MPCNL比较,多通道MPCNL在清除复杂性、多发性结石中的应用效果较好,但多通道MPCNL对患者机体及医师的技术要求较高,且术后并发症较多,建议临床根据患者具体病情合理建立通道。

Objective To investigate the effect of single-channel minimally invasive percutaneous nephrolithotomy(MPCNL)and multi-channel MPCNL on patients with upper urinary calculi.Methods A retrospective study was performed on 230 cases of patients with urinary stones who were admitted from June 2015 to September 2019,125 males and 105 famales,with the age of(41.20±10.32)years old,ranging from 20 to 71 years old.The patients were divided into the single-channel group(n=112)and the multi-channel group(n=118)according to the operation method.with the age of(41.20±10.32)years old,ranging from 20 to 71 years old.The therapeutic effect,perioperative indexes,renal function and complications of the two groups were observed and compared.Results There was no significant difference between the two groups(P>0.05).The operation time and postoperative hospitalization time of the patients in the multichannel Group[(84.25±11.26)min,(13.68±2.27)d]were shorter than those in the single channel group[(101.35±12.34)min,(16.44±3.21)d],and the difference was statistically significant(P<0.05).There was no significant difference in intraoperative blood loss and urine clearance time between the two groups(P>0.05).The operation time and postoperative hospitalization time of the patients in the multichannel Group[(84.25±11.26)min,(13.68±2.27)d]were shorter than those in the single channel group[(101.35±12.34)min,(16.44±3.21)d],and the difference was statistically significant(P<0.05).There was no significant difference in the one-time stone clearance rate between the multi-channel group and the single-channel group(P>0.05).There was no significant difference in the indexes between the two groups before surgery(P>0.05).Conclusion Single channel MPCNL on the clear majority of urinary stones has good treatment effect,compared with single channel MPCNL,multi-channel MPCNL remove complexity,multiple calculus in the application effect is good,but the multi-channel MPCNL technical requirements of the patient′s body and the physician is higher,and the postoperative complications,more reasonable suggestions according to the specific patient clinical channel is established.