经皮肾镜联合输尿管软镜治疗肾结石伴肾功能不全老年患者的临床效果分析

Clinical analysis of percutaneous nephrolithotomy combined with ureteroscopy in the treatment of elderly patients with renal calculi and renal insufficiency

目的探讨经皮肾镜(PCNL)联合输尿管软镜(FU)治疗肾结石伴肾功能不全老年(>60岁)患者的临床效果。方法选取本院2015年1月至2017年10月拟实施肾结石手术的肾结石伴肾功能不全患者120例作为研究对象进行前瞻性研究,其中60例采用PCNL手术(对照组),另外60例患者采用PCNL+FU手术治疗(联合组)。对比两组患者的结石清除率、手术时间及住院时间,检测并对比两组患者术前、术后3、7 d的血肌酐(Scr)、血胱抑素C(Cys C)、尿中性粒细胞明胶酶相关脂质运载蛋白(NAGL)及手术并发症发生率。结果联合组的结石清除率高于对照组(P<0.05),联合组的手术时间低于对照组(P<0.05),联合组的住院时间与对照组比较,差异无统计学意义(P>0.05);术前,联合组和对照组的Scr、Cys C、NAGL水平比较,差异无统计学意义(P>0.05);术后3、7 d,联合组的Scr、Cys C、NAGL水平均低于对照组(P<0.05);联合组的手术并发症发生率为6.67%(4/60),低于对照组的20.00%(12/60),差异有统计学意义(P<0.05)。结论 PCNL联合FU治疗肾结石伴肾功能不全患者在保证清除肾结石的基础上,对患者肾功能的影响更小。

Objective To investigate the effect of percutancous nephrolithotomy(PCNL)com-bined with ureteroscopy(FU)in the treatment of patients with renal calculi and renal insufficiency.Methods A prospective study was performed in 120 patients who underwent renal calculus surgery from January 2015 to October 2017 in our hospital.Sixty patients underwent PCNL surgery(control group)and 60 patients underwent PCNL+FU surgery(combined group).Comparing The stone clear-ance rate,operation time and hospitalization time of the two groups were compared.The serum creati-nine(Ser)and cystatin C(Cys C)of the two groups before surgery,3 days after surgery and 7 days af-ter surgery were compared.Urinary neutrophil gelatinase associated lipocalin(NAGL)and operative complication rate were compared.Results The stone removal rate of the combined group was bhigher than that of the control group(P<0.05).The operation time of the combined group was lower than that of the control group(P<0.05).There was no sigificant difference between the combined group and the control group(P>0.05).There were no significant differences in the levels of Ser,Cys C and NA-GL between the combined group and the control group before operation(P>0.05).On the3 rd and 7 th day after surgery,the Scr,Cys C and NAGL levels in the combined group were lower than those in he comrol goup(P<0.05).The oentive rule of6.67%in the combined group was lower han 20.00%in the control group,and the dferencee was saisicallyl sgican(P<0.05).Conclusions PCNA combined with FU in the tetment of renal caculus with renal inufcinc.on the basis of cnsuring he removal of kidney soes,the ipaet on pliets with renal functon is smlle.