组合式输尿管软镜治疗老年肾结石效果分析

Use of Modular Flexible Ureteroscopy in the Treatment of Kidney Stone

目的探讨组合式输尿管软镜治疗老年肾结石患者的临床应用及治疗效果。方法选取吉林大学第二医院2014年5月~2018年5月收治的老年肾结石患者120例,随机分为2组,对照组行经皮肾镜碎石取石术(PCNL),观察组行组合式输尿管软镜钬激光碎石术(RIRS)。对比两组手术时间、术后血红蛋白下降值、住院时间;统计两组术后结石清除率及术后并发症发生率;比较两组术前及术后氧化应激损伤指标丙二醛(MDA)、超氧化物歧化酶(SOD)水平。结果观察组手术时间明显长于对照组,而住院总时间及术后血红蛋白下降值明显优于对照组(P<0.05);观察组总结石清除率与对照组比较差异无统计学意义(P>0.05);观察组围手术期并发症发生率明显低于对照组(P<0.05);两组术前血清MDA、SOD水平比较,差异无统计学意义(P>0.05),术后两组MDA、SOD水平均有明显变化,且观察组血清MDA水平低于对照组,SOD水平高于对照组,差异均有统计学意义(P<0.05)。结论RIRS和PCNL治疗老年肾结石均能达到令人满意的程度,与PCNL比较RIRS在对机体损伤、术后出血、并发症发生率及氧化应激方面比较有优势,术后舒适度较好且有利于老年患者早期康复。

Objective To explore the application and effect of modular ureteroscopy in the treatment of older patients with kidney stone.Methods 120 older patients with kidney stone in the Second Hospital of Jilin University from May 2014 to May 2018 were randomly divided into the control group and the observation group.Percutaneous nephrolithotripsy(PCNL)was performed in the control group.Modular flexible ureteroscopic retrograde intrarenal surgery(RIRS)was performed in the observation group.The time of operation,the level of hemoglobin,the length of hospitalization,the rate of postoperative stone clearance and the incidence of postoperative complications were documented.The levels of malondialdehyde(MDA)and superoxide dismutase(SOD)were tested before and after operation.Results The operation time was significantly longer,the hospitalization time and the decrease of postoperative hemoglobin level were significantly less in the observation group than those in the control group(P<0.05).There was no significant difference in overall stone clearance between the two groups(P>0.05).The incidence of perioperative complications in the observation group was significantly lower than that in the control group(P<0.05).There were no significant differences in the levels of MDA and SOD before operation between the two groups.MDA level was increased and SOD level was decreased in the two groups after operation,MDA level was lower and SOD level was higher in the observation group than those in the control group(P<0.05).Conclusion Both RIRS and PCNL might achieve satisfactory therapeutic efficacy in the treatment of kidney stone in older patients.Compared with PCNL,RIRS has advantages in reducing body injury,postoperative bleeding,complications and oxidative stress.Better postoperative comfort of RIRS may be beneficial to the early recovery of older patients.