超声引导标准通道联合mini-PCNL治疗鹿角形肾结石的疗效及安全性研究

Efficacy and safety of ultrasound-guided standard channel combined with mini-PCNL in the treatment of staghorn kidney stones

目的探讨超声引导标准通道联合一期微通道经皮肾镜取石术(mini-PCNL)治疗鹿角形肾结石的临床疗效及其安全性。方法选取山东省立第三医院泌尿外科2019年1月至2020年5月间收治的80例诊断为鹿角形肾结石的患者作为研究对象,按照随机数表法将患者分为观察组和对照组,每组40例。对照组患者采用多通道mini-PCNL取石治疗,观察组患者采用泌尿专用超声引导标准通道联合一期mini-PCNL取石治疗。比较两组患者的手术完成情况、手术相关指标及术后并发症发生情况,并对两组患者的结石成分进行分析。结果观察组患者的手术时间和住院时间分别为(61.52±13.44)min、(5.87±1.06)d,明显短于对照组的(89.06±15.73)min、(7.54±1.83)d,差异均具有统计学意义(P<0.05);观察组患者的术中肾盂内压力为(14.73±2.56)mmHg,明显低于对照组的(21.96±3.81)mmHg,差异具有统计学意义(P<0.05);观察组患者的一期结石清除率为90.0%,明显高于对照组的67.5%,二期经皮肾术患者的比例为2.5%,明显低于对照组的20.0%,差异均具有统计学意义(P<0.05);观察组患者的并发症发生率为12.5%,明显著低于对照组的35.0%,差异具有统计学意义(P<0.05);两组患者术后结石成分比较差异均无统计学意义(P>0.05)。结论对鹿角星肾结石患者进行泌尿超声引导标准通道联合mini-PCNL取石治疗,能够有效减少患者的术中肾盂压力、提升手术效率、减少住院时间,同时还能显著减少并发症的发生,具有良好的临床推广应用价值。

Objective To investigate the clinical efficacy and safety of ultrasound-guided standard channel combined with one-stage minimally access percutaneous nephrolithotomy(mini-PCNL) in the treatment of staghorn kidney stones. Methods A total of 80 patients diagnosed with staghorn kidney stones, who admitted to Department of Urology, the Third Hospital of Shandong Province from January 2019 to May 2020, were selected and divided into the observation group and control group according to random number table method, with 40 patients in each group. The patients in the control group were treated with multi-channel mini-PCNL for stone removal, and the patients in the observation group were treated with urinary ultrasound-guided standard channel combined with first-stage mini-PCNL for stone removal. The operation completion, operation-related indexes and postoperative complications of the two groups of patients were compared. The stone composition of the two groups were analyzed. Results The operation time and hospitalization time of the observation group were(61.52±13.44) min and(5.87±1.06) d, which were significantly shorter than corresponding(89.06±15.73) min and(7.54±1.83) d of the control group(P<0.05);the intraoperative renal pelvis pressure of the observation group was(14.73±2.56) mmHg, which was significantly lower than(21.96±3.81) mmHg of the control group(P<0.05);the first-stage stone clearance rate of the observation group was 90.00%, which was significantly higher than 67.50% of the control group(P<0.05);the proportion of patients in the observation group undergoing second-stage percutaneous nephrectomy was 2.50%, which was significantly lower than 20.00% in the control group(P<0.05);the incidence of complications in the observation group was 12.50%, which was significantly lower than 35.00%in the control group(P<0.05);there was no significant difference in the analysis of postoperative stone composition between the two groups of patients(P>0.05). Conclusion Urinary ultrasound-guided standard channel combined with mini-PCNL stone removal treatment for patients with staghorn star kidney stones can effectively reduce the patient’s intraoperative renal pelvis pressure, improve surgical efficiency, reduce hospital stay, and also significantly reduce the incidence of complications, and it has better promotion value.