微通道经皮肾镜碎石取石术治疗复杂性肾结石的临床疗效及安全性观察

Clinical Efficacy and Safety of Microchannel Percutaneous Nephrolithotomy in Treatment of Complex Renal Calculi

目的:探讨标准通道及微通道经皮肾镜取石术(PCNL)对复杂性肾结石患者的临床疗效及安全性。方法:140例行PCNL治疗的复杂性肾结石患者,根据手术通道的不同分为(对照组,n=70)及(研究组,n=70),比较两组治疗效果、手术情况、手术前后肾小球滤过率变化、术后并发症及手术前后血清炎性因子水平变化。结果:研究组治疗效果显著优于对照组(P<0.05);研究组术中出血量明显少于对照组(P<0.05),但手术持续时间明显长于对照组(P<0.05);研究组术后下床活动时间、住院天数均明显短于对照组(P<0.05);研究组结石清除率与对照组比较差异无统计学意义(P>0.05);研究组术后并发症发生率低于对照组(P <0.05);两组术前的肾小球滤过率比较,无差异(P>0.05);两组术后肾小球滤过率均有升高,研究组术后的肾小球滤过率高于对照组(P<0.05);与术前比较术后3 d两组血清降钙素原(PCT)以及研究组血清C反应蛋白(CRP)水平均升高,且研究组上述指标均高于对照组(P<0.01)。结论:微通道经皮肾镜碎石取石术治疗复杂性肾结石的效果显著,具有创伤小、术中出血少、术后恢复快且并发症发生率低等优点,可更有效改善血清炎性因子水平,值得推广应用。

Objective: To investigate the clinical efficacy and safety of standard channel and micro-channel percutaneous nephrolithotomy(PCNL) in patients with complex kidney stones. Methods: A total of 140 patients with complex kidney stones treated with PCNL were divided into two groups according to the different surgical channels(control group, n = 70) and(study group, n = 70).The treatment effect, operation condition, changes in glomerular filtration rate before and after operation, postoperative complications and changes in serum inflammatory factors before and after operation were compared between the two groups. Results: The treatment effect of the study group was significantly better than that of the control group(P<0.05). The amount of intraoperative blood loss in the study group was significantly less than that in the control group(P<0.05), but the duration of operation was significantly longer than that in the control group(P<0.05). Postoperative ambulation time and hospitalization days in the study group were significantly shorter than those in the control group(P<0.05). There was no significant difference in stone clearance rate between the study group and the control group(P>0.05). The incidence of postoperative complications in the study group was lower than that in the control group(P<0.05). There was no difference in the preoperative glomerular filtration rate between the two groups(P>0.05). The postoperative glomerular filtration rate of the two groups was increased, and that of the study group was higher than that of the control group(P<0.05). Compared with preoperative and postoperative 3 d, serum PCT and CRP levels in the two groups were both increased, and the above indexes in the study group were higher than those in the control group(P<0.01). Conclusion: The micro-channel percutaneous nephrolithotomy is effective in the treatment of complex kidney stones. It has the following advantages: less trauma, less intraoperative bleeding, faster postoperative recovery, and low complication rate. It can more effectively improve serum inflammation, which is worthy of promotion and application.