多通道经皮肾镜与单通道PCNL联合输尿管软镜治疗复杂性肾结石的临床疗效及安全性比较

Comparison of clinical efficacy and safety between multi-channel percutaneous nephrolithotomy and single channel PCNL combined with ureteroscope in the treatment of complex renal calculi

目的研究复杂性肾结石治疗中多通道经皮肾镜(PCNL)与单通道PCNL联合输尿管软镜(FURSL)的临床疗效及安全性。方法采用回顾性分析方法,研究对象为2019年1月至2020年1月丹东市第一医院收治的84例复杂性肾结石患者,根据治疗方式的不同分为对照组(n=42)和研究组(n=42)。对照组选用多通道PCNL治疗,研究组选用单通道PCNL联合FURSL治疗。比较2组患者手术前后血肌酐水平与手术时间、术后血红蛋白下降值、清石率及并发症发生率。结果手术前后2组患者血肌酐水平比较[手术前:(0.91±0.18)mg/dL vs.(0.93±0.20)mg/dL;手术后:(0.94±0.21)mg/dL vs.(0.92±0.19)mg/dL],差异均无统计学意义(P>0.05);研究组较对照组手术时间更长[(120.08±16.41)min vs.(106.07±15.86)min],术后血红蛋白下降值更低[(9.95±3.76)g/L vs.(14.42±7.09)g/L],差异有统计学意义(P<0.05)。2组患者清石率及并发症发生率比较(92.86%vs.88.09%、4.76%vs.7.14%),差异无统计学意义(P>0.05)。结论多通道PCNL与单通道PCNL联合FURSL治疗复杂性肾结石均有显著疗效,并发症均较少,安全性高。多通道PCNL手术时间更短,而单通道PCNL联合FURSL出血量更少,临床医师可参考患者实际情况选取相应术式进行治疗。

Objective To study the clinical efficacy and safety of percutaneous nephrolithotho lithotomy(PCNL)and single channel PCNL combined with flexible ureteroscope lithotripsy(FURSL)in the treatment of complex kidney stones.Methods Retrospective analysis was performed on 84 patients with complex kidney stones who were admitted to Dandong First Hospital January from 2019 to January 2020.The subjects were divided into two groups according to different treatment methods:one group was the control group(42 cases),the other group was the study group(42 cases).The control group was treated with multi-channel PCNL,while the study group was treated with single-channel PCNL combined with FURSL.The changes of serum creatinine level,operation time,decreased hemoglobin,clear stone rate and complication rate before and after operation were compared between the two groups.Results There was no significant difference in serum creatinine levels between the two groups before and after surgery[before surgery:(0.91±0.18)mg/dL vs.(0.93±0.20)mg/dL;after surgery:(0.94±0.21)mg/dL vs.(0.92±0.19)mg/dL](P>0.05).There was no significant difference in serum creatinine levels between the two groups before and after operation(P>0.05).The operation time of the study group was longer than that of the control group[(120.08±16.41)min vs.(106.07±15.86)min],and the decrease value of hemoglobin after operation was lower[(9.95±3.76)g/L vs.(14.42±7.09)g/L](P<0.05).There was no significant difference in serum creatinine level,stone clearing rate and complication rate between the two groups(92.86%vs.88.09%、4.76%vs.7.14%)(P>0.05).Conclusion Both multi-channel PCNL and single-channel PCNL combined with FURSL have significant efficacy in the treatment of complex kidney stones,with fewer complications,higher safety,shorter operation time for multi-channel PCNL,and less blood loss for single-channel PCNL combined with FURSL.Clinicians can select the appropriate surgical method for treatment according to the actual situation of patients.