建立F24与F16通道经皮肾镜取石治疗对肾结石患者的影响

Effects of percutaneous nephrolithotomy with establishment of F24 channel and F16 channel on patients with renal calculi

目的探讨建立F24通道与F16通道经皮肾镜取石治疗对肾结石患者的影响。方法选择2016年4月~2018年4月于我院接受经皮肾镜取石术(PCNL)治疗的肾结石患者80例,按通道口径大小分为F24通道组43例与F16通道组37例,F24通道组予以球囊扩张法建立F24通道,F16通道组予以筋膜扩张法建立F16通道,比较两组患者围术期指标、血流动力学、生化指标及术后并发症情况。结果与F16通道组比较,F24通道组术中肾盂内压、术中出血量、术中输血率、一期结石清除率明显更低,手术时间明显更短(P<0.05);F24通道组术后肾盂内压、术后输血率明显更低,碎石时间、住院时间明显更短(P<0.05);术后,两组HR无显著变化(P>0.05),两组MAP显著升高(P<0.05),差异比较无统计学意义(P>0.05);术后1d,两组PCT、CRP、MCP-1、HMGB1水平显著升高(P<0.05),TFF1水平显著降低(P<0.05),术后3d,两组PCT、CRP、MCP-1、HMGB1水平较术后1d显著降低(P<0.05),TFF1水平显著升高(P<0.05),术后3d,F24通道组PCT、CRP、MCP-1、HMGB1水平显著低于F16通道组(P<0.05),TFF1水平显著高于F16通道组(P<0.05);F24通道组并发症总发生率46.51%显著低于F16通道组的89.19%(P<0.05)。结论与建立F16通道PCNL治疗比较,建立F24通道PCNL治疗肾结石效果更好,生化水平指标更优,并发症发生率更低。

Objective To explore the effects of percutaneous nephrolithotomy with establishment of F24 channel and F16 channel on perioperative indexes,hemodynamics and postoperative complications in patients with renal calculi.Methods 80 patients with renal calculi treated with percutaneous nephrolithotomy(PCNL)in our hospital from April 2016 to April 2018 were selected and divided into F24 channel group and F16 channel group according to the channel size.43 cases in F24 channel group were given balloon expansion to establish F24 channel,and 37 cases in F16 channel group were given fascial expansion to establish F16 channel.The perioperative indexes,hemodynamics,biochemical parameters and postoperative complications were compared between the two groups.Results The intraoperative renal pelvic pressure,intraoperative blood loss,intraoperative blood transfusion rate and one-stage stone clearance rate in F16 channel group were significantly lower than that in F24 channel group,and the operative time in F16 channel group was significantly shorter lower than that in F24 channel group(P<0.05).The postoperative renal pelvis pressure and postoperative blood transfusion rate in F24 channel group were significantly lower than that in F16 channel group,and the lithotripsy tiem and hospital stay in F24 channel group were significantly shorter than that in F16 channel group(P<0.05).After operation,there was no significant change in HR between the two groups(P>0.05),and the MAP in the two groups was significantly increased(P>0.05),and the difference was not statistically significant(P>0.05).At 1d after operation,the levels of PCT,CRP,MCP-1 and HMGB1 were significantly increased(P<0.05)while the level of TFF1 was significantly decreased(P<0.05).At 3d after operation,the levels of PCT,CRP,MCP-1 and HMGB1 in the two groups were significantly decreased compared with those at 1d after operation(P<0.05)while the TFF1 level was significantly increased(P<0.05).At 3d after operation,the levels of PCT,CRP,MCP-1 and HMGB1 in F24 channel group were significantly lower than those in F16 channel group(P<0.05),while the level of TFF1 was significantly higher than that in F16 channel group(P<0.05).The total incidence rate of complications in F24 channel group was significantly lower than that in F16 channel group(46.51%vs 89.19%)(P<0.05).Conclusion Compared with PCNL with establishment of F16 channel,PCNL with establishment of F24 channel has better effects in the treatment of renal calculi,and it has better biochemical indexes and lower incidence rate of complications.