输尿管软镜、针状肾镜治疗上尿路结石的临床对照研究

A Comparative Study of Flexible Ureteroscopy and Needle-like Nephroscopy in the Treatment of Upper Urinary Calculi

目的:比较输尿管软镜碎石术(flexible ureteroscopy lithotripsy,FURL)与针状肾镜行经皮肾镜取石术(percutaneous nephrostolithotomy,PCNL)治疗上尿路结石的临床效果。方法:选择2017年7月-2018年7月本院收治的99例上尿路结石患者,依照随机数字表法将患者分为对照组49例,研究组50例,分别采PCNL术式与FURL术式治疗上尿路结石,对比两种治疗方式的临床效果。结果:对照组患者的结石清除率为97.96%(48/49),研究组为96.00%(48/50),差异无统计学意义(P>0.05);研究组术后各肾功能相关指标与对照组对比,差异均无统计学意义(P>0.05);术后,研究组IL-10、CRP、WBC水平均显著低于对照组(P<0.05);研究组术后ACTH、NE、MDA水平均低于对照组,COR、SOD均高于对照组(P<0.05);研究组术后并发症发生率显著低于对照组(P<0.05)。结论:FURL与PCNL均可有效治疗直径≤2 cm的上尿路结石,结石清除率与肾功能影响对比无显著差异。FURL术后患者并发发生率低,对炎性因子、氧化应激以及应激激素水平影响小,推荐FURL是治疗上尿路结石较为理想的手术方案。

Objective:To compare the clinical effect of flexible ureteroscopy lithotripsy(FURL)with percutaneous nephrolithotomy(PCNL)for treatment of upper urinary calculi.Method:A total of 99 patients with upper urinary calculi admitted between July 2017 and July 2018 were selected.According to the random number table method,the two groups of patients were divided into control group(49 cases)and study group(50 cases).PCNL and FURL surgeries were used to treat upper urinary calculi respectively,and the clinical effects of the two treatment methods were compared.Result:The stone clearance rate was 97.96%(48/49)in the control group and 96.00%(48/50)in the study group,the difference was not statistically significant(P>0.05).There were no significant differences in renal function indexes between two groups(P>0.05).The levels of IL-10,CRP,WBC and other inflammatory factors in the study group were significantly lower than those in the control group(P<0.05).The levels of ACTH,NE and MDA in the study group were significantly lower than those in the control group,COR,SOD were higher than that of the control group(P<0.05).The incidence of postoperative complications was significantly lower in the study group than in the control group(P<0.05).Conclusion:FURL and PCNL were effective in treating upper urinary calculi with diameter≤2 cm,and there is no significant difference in stone clearance rate and renal function.FURL has a low incidence of postoperative complications and has little impact on inflammatory factors,oxidative stress and stress hormone levels,therefore,FURL is recommended as an ideal surgical procedure for the treatment of upper urinary calculi with diameter≤2 cm.