经输尿管导管RSUG在复杂肾结石经皮肾镜治疗中的诊治价值

The diagnosis and treatment value of RSUG via ureteral catheter in percutaneous nephroscope treatment of complex kidney stones

目的探讨经输尿管导管逆行超声造影在复杂肾结石患者经皮肾镜治疗中的应用价值。方法选取本院2017年1月至2019年3月收治的复杂肾结石患者106例作为研究对象。按照随机数字表法分两组,各53例。两组均行经皮肾镜治疗,对照组给予传统单纯超声定位引导,观察组给予经输尿管导管逆行超声造影引导。比较两组手术情况、住院时间、穿刺情况、结石清除情况、术前、术后1、3 d肾功能指标、炎性因子水平及并发症发生率,并随访6个月,统计对比两组结石复发率。结果观察组术中失血量少于对照组,手术时间、住院时间短于对照组,一次性穿刺成功率、Ⅰ期结石清除率高于对照组(P<0.05);两组术后1、3 d血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和胱抑素C(Cys-C)、血尿酸(BUA)、血管紧张素Ⅱ(AngⅡ)、干扰素-γ(IFN-γ)、C反应蛋白(CRP)水平高于治疗前,观察组低于对照组(P<0.05);观察组并发症发生率5.66%低于对照组20.75%(P<0.05);随访6个月,两组结石复发率相比,差异无统计学意义(P>0.05)。结论经输尿管导管逆行超声造影应用于复杂肾结石患者经皮肾镜治疗中,效果显著,安全性高,且复发率低。

Objective To explore the application value of retrograde contrast-enhanced ultrasound via ureteral catheter in the percutaneous nephrolithiasis treatment of patients with complex renal stones.Methods A total of 106 patients with complex renal stones treated in our hospital from January 2017 to March 2019 were selected as the research objects and grouped according to random number table method,53 cases each.Both groups were treated with percutaneous nephroscope,the control group was given traditional ultrasound positioning guidance alone,and the observation group was given retrograde contrast-enhanced ultrasound guidance via ureteral catheter.The operation status,hospitalization time,puncture status,stone removal status,renal function indexes,levels of inflammatory factors before and after 1,3 days after the operation and the incidence of complications were compared between the two groups.Followed up for 6 months,and the recurrence rates of stones in the two groups were statistically compared.Results The intraoperative blood loss of the observation group was less than that of the control group,and the operation time and hospital stay were shorter than those of the control group.The success rate of one-time puncture and the removal rate of stageⅠstones were higher than those of the control group(P<0.05).Serum neutrophil gelatinaseassociated lipocalin(NGAL),cystatin C(Cys-C),blood uric acid(BUA),angiotensinⅡ(AngⅡ),interferon-γ(IFN-γ),C-reactive protein(CRP)levels in the two groups were higher than before treatment on the 1st and 3rd day after operation,while the observation group was lower than the control group(P<0.05).The complication rate of the observation group was 5.66%lower than that of the control group 20.75%(P<0.05).After 6 months of follow-up,there was no significant difference in the recurrence rate of stones between the two groups(P>0.05).Conclusion Retrograde contrast-enhanced ultrasound via ureteral catheter is used in the percutaneous nephrolithiasis treatment of patients with complex kidney stones,with significant effects,high safety,and low recurrence rate.