后腹腔镜下肾盂切开取石术与经皮肾镜碎石术治疗大于2厘米单发肾盂结石的疗效分析

Analysis of the efficacy of retroperitoneal laparoscopic pyelolithotomy and percutaneous nephrolithotomy for the treatment of single pyelone stones larger than 2 cm

目的探讨后腹腔镜下肾盂切开取石术与经皮肾镜碎石术治疗直径大于2 cm单发肾盂结石的疗效及安全性。方法前瞻性选择2015年1月至2020年1月北京市大兴区人民医院泌尿外科收治的80例单发肾盂结石患者,按照随机数表法均分为2组。40例行后腹腔镜下肾盂切开取石术(RLP)的患者设为RLP组,40例行经皮肾镜碎石术(PCNL)的患者设为PCNL组。对比2组手术相关参数、结石清除率、术中和术后并发症、术后肾功能指标[尿素氮(BUN)、肌酐(Scr)]、应激指标[皮质醇(Cor)、一氧化氮(NO)]、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)]。结果RLP组术中失血量、术后血红蛋白降低值均低于PCNL组,而手术时间、住院时间大于PCNL组,差异均有统计学意义(P<0.05)。RLP组术中并发症发生率(2.50%)明显低于PCNL组(15.00%),差异有统计学意义(P<0.05)。RLP组与PCNL组术后并发症发生率(27.50%vs.35.00%)比较,差异无统计学意义(P>0.05)。术后3 d,2组患者的BUN、Scr水平比较,差异无统计学意义(P>0.05),但RLP组患者Cor、NO水平明显低于PCNL组,差异均有统计学意义(P<0.05)。术后3 d,RLP组患者IL-6、hs-CRP、TNF-α水平均明显低于PCNL组,差异均有统计学意义(P<0.05)。结论2种方式均为治疗单发肾盂结石安全、有效的方法,但RLP较PCNL术中失血量少,且创伤程度明显更小。

Objective To investigate the efficacy and safety of retroperitoneal laparoscopic pyelolithotomy and percutaneous nephrolithotomy in the treatment of single renal pelvis stones larger than 2 cm in diameter.Methods From January 2015 to January 2020,80 patients with single renal pelvic calculi admitted to the Department of Urology,Daxing District People's Hospital in Beijing were prospectively selected and divided into two groups by random number table method.Forty patients who underwent retroperitoneal pelvic lithotripsy(RLP)were set as RLP group,and 40 patients who underwent percutaneous nephrolithotomy(PCNL)were set as PCNL group.Stress indexes[cortisol(COR),nitric oxide(NO)],High sensitivity C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α)]were compared.Results The intraoperative blood loss and postoperative hemoglobin reduction of the RLP group were lower than those of the PCNL group,while the operation time and hospital stay were longer than those of the PCNL group,and the differences were statistically significant(P<0.05).The incidence of intraoperative complications in the RLP group(2.50%)was significantly lower than that in the PCNL group(15.00%),and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications between the RLP group and the PCNL group(27.50%vs.35.00%)(P>0.05).Three days after operation,there was no significant difference in the levels of BUN and Scr between the two groups(P>0.05),but the levels of Cor and NO in the RLP group were significantly lower than those in the PCNL group,and the differences were statistically significant(P<0.05)).Three days after operation,the levels of IL-6,hs-CRP and TNF-αin the RLP group were significantly lower than those in the PCNL group,and the differences were statistically significant(P<0.05).Conclusion Both methods are safe and effective for the treatment of single renal pelvis stones.Compared with PCNL,RLP has less intraoperative blood loss,but more trauma and slower recovery.