输尿管软镜与经皮肾镜治疗肾结石的效果比较

Comparison of flexible ureteroscopic lithotripsy and percutaneous nephrolithotripsy in treatment of kidney stones

探讨输尿管软镜碎石术(FURL)和经皮肾镜碎石术(PCNL)治疗肾结石的效果及对患者肾功能的影响。将2016年1月~2019年1月95例肾结石患者依据手术方式分为FURL组(50例)和PCNL组(45例),对比两组手术情况、结石清除率、并发症情况、手术前后肾功能[胱抑素C(CysC)、血肌酐(Scr)及尿肾损伤因子(KIM-1)]差异。FURL组手术时长、下床时间、住院时间以及术后VAS评分均小于PCNL组(P<0.05)。FURL术对肾盂结石和小负荷肾结石的清除率显著高于PCNL组,FURL术对肾下盏结石和大负荷肾结石的清除率则低于PCNL组(P<0.05)。两组术后并发症发生率差异无统计学意义(P<0.05);术后3 d,FURL组患者血清CysC、Scr、尿KIM-1水平均显著低于PCNL组(P<0.05)。FURL术和PCNL术对3cm以内肾结石的清除效果相当,但FURL术创伤小、并发症少,对患者肾功能影响较小。

The aim of this study is to investigate the influences of flexible ureteroscopic lithotripsy(FURL)and percutaneous nephrolithotripsy(PCNL)on renal function and oxidative stress indexes in patients with kidney stones.95 patients with kidney stones were divided into FURL group(50 cases)and PCNL group(45 cases)according to the operation method from Jan 2016 to Jan 2019.The differences in operation status,stone clearance rate,complications,renal function[cystatin C(CysC),blood creatinine(Scr),urinary kidney injury factor(KIM-1)]were compared between the two groups.The operation duration,time of getting out of bed,length of stay and postoperative VAS score in FURL group were all lower than PCNL group(P<0.05).The clearance rate of FURL for pyelolithiasis and low-load calculi was significantly higher than PCNL group,while the clearance rate of FURL for subrenal calyces calculi and high-load calculi was lower than PCNL group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P<0.05).Three days after surgery,serum levels of CysC,Scr,urinary KIM-1 in FURL group were significantly lower than PCNL group(P<0.05).FURL and PCNL have the same effect on the removal of kidney stones,but FURL has less trauma,fewer complications and less effect on renal function.