微创钬激光碎石术与开放性取石术治疗复杂性肾结石的临床疗效

Clinical Effect on Patients with Complicated Renal Calculi: Minimally Invasive Holmium Laser Lithotripsy vs. Open Stone Removal

目的探索对比经皮肾镜联合输尿管软镜钬激光碎石术与开放性肾切开取石术治疗复杂性肾结石的临床效果。方法选取2016年6月至2018年7月,复杂性肾结石患者168例,按照随机数表法分为两组,对照组患者84例,应用开放性取石术治疗;观察组患者84例,应用微创钬激光碎石术治疗,激光波长2140 nm,碎石功率30 W。术后7和14 d,记录两组患者结石清除率、术后下床时间和住院天数,检测术前1 d和术后1 d血清蛋白浓度、血肌酐指标水平。并观察两组患者术后并发症发生情况。结果观察组结石清除率(88.1%)明显高于对照组(61.9%);观察组住院天数(6.43±1.0)d明显少于对照组(12.7±2.2)d,两组差异具有统计学意义(P<0.05)。观察组术后血清蛋白浓度(116.5±23.7)g/L明显高于对照组(98.4±19.1)g/L;观察组血肌酐指标水平(4.38±0.5)μmol/L显著低于对照组(6.82±1.0)μmol/L,两组比较差异具有统计学意义(P<0.05)。对照组4例肾盂输尿管损伤,2例尿瘘,8例感染,4例大出血;观察组2例肾盂输尿管损伤,2例感染。观察组并发症总发生率(4.76%)明显低于对照组(21.4%),差异具有统计学意义(P<0.05)。结论经皮肾镜联合输尿管软镜钬激光碎石术较开放性肾切开取石术治疗复杂性肾结石清除效果好,可明显改善患者血清指标情况和降低并发症发生率,值得临床推广应用。

Objective To explore the clinical effect of percutaneous nephrolithotomy plus ureteroscope holmium laser lithotripsy and open renal incision for the treatment of complicated renal calculi.Methods Totally 168 patients with complex kidney stones from Jun.2016 to Jul 2018 were divided randomly into two groups:the control group(open lithotripsy group) and observation group(minimally invasive holmium laser lithotomy group).The stone clearance rate,postoperative bedtime and hospitalization days of the patients in both groups were recorded.Their serum protein concentration and serum creatinine levels were measured before and after the surgery respectively.Their postoperative complications of the two groups were observed and recorded.Results The stone removal rate of the observation group was 88.1%,which was significantly higher than that of the control group(61.9%).The hospitalization length in the observation group was(6.43±1.0) days,which was significantly shorter than that,i.e.,(12.7±2.2) days,in the control group(P<0.05).The serum protein concentration of the observation group was(116.5±23.7) g/L,which was significantly higher than that of the control group,i.e.,(98.4±19.1) g/L.The serum creatinine index of the observation group was(4.38±0.5) μmol/L.which was significantly lower than that,i.e.,(6.82±1.0) μ mol/L,of the control group(P<0.05).In the control group,4 cases of ureteral injury,2 case of urinary fistula,8 cases of infection and 4 cases of massive hemorrhage were observed.One case of ureteral ureteral injury and one case of infection were observed in the observation group.The total incidence of complications in the observation group was 4.76%,which was significantly lower than that,i.e.,21.4%,of the control group(P<0.05).Conclusions Percutaneous nephrolithotomy plus ureteroscope holmium laser lithotripsy is more effective than open-ended renal incision in treating complicated renal stones.It will significantly improve the serum index and reduce the incidence of complications,which means it is suitable for clinical application.