微通道经皮肾镜联合输尿管软镜与输尿管软镜钬激光碎石术治疗复杂肾结石疗效及对肾功能的影响

Microchannel percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy and simple flexible ureteroscopic lithotripsy in the treatment of complex renal calculi and its effect on renal function

目的比较微通道经皮肾镜取石术(mPCNL)联合输尿管软镜钬激光碎石术(FURL)与单纯FURL治疗复杂肾结石(CRC)的疗效及对肾功能的影响。方法采用回顾性研究方法,将2019年1月至2021年5月苏州大学附属第一医院收治的96例CRC患者纳入本次研究,根据治疗方式不同将其分为A组(n=48)和B组(n=48)。A组选择FURL治疗,B组选择mPCNL联合FURL治疗。比较两组患者围手术期相关指标、碎石成功率、手术前后肾功能及血清白细胞介素-6(IL-6)、C反应蛋白(CRP)水平以及并发症发生情况。结果B组手术时间、术后住院时间为(136.2±12.8)min、(8.6±1.9)d,明显长于A组[(113.8±11.6)min、(5.8±1.5)d],术中出血量为(67.7±10.8)mL,多于A组[(26.9±9.5)mL],差异均有统计学意义(P<0.05)。B组一次碎石成功率为100.0%,显著高于A组的83.3%,差异有统计学意义(P<0.05)。B组术后的肌酐和尿素氮分别(78.95±9.12)μmol/L、(7.01±1.13)mmol/L,A组分别为(77.34±8.91)μmol/L、(6.69±1.10)mmol/L,两组术后肌酐和尿素氮水平比较,差异均无统计学意义(P>0.05)。B组术后血清IL-6、CRP水平分别为(16.82±1.71)ng/L、(22.72±3.55)mg/L,A组为(17.54±1.44)ng/L、(23.67±4.01)mg/L,两组术后血清IL-6、CRP水平比较,差异均无统计学意义(P>0.05)。B组并发症发生率为6.25%,与A组的10.42%相比,差异无统计学意义(P>0.05)。结论CRC患者选取mPCNL联合FURL治疗效果良好,安全性较高,可提高一次碎石成功率,对肾功能的影响较小。

Objective To compare the efficacy of microchannel percutaneous nephrolithotomy(mPCNL)combined with flexible ureteroscopic lithotripsy(FURL)and simple FURL in the treatment of complex renal calculi(CRC)and its effect on renal function.Methods Ninety-six patients with CRC treated in the First Affiliated Hospital of Soochow University from January 2019 to May 2021 were prospectively enrolled in this study,and divided into group A(n=48)and group B(n=48)according to the different treatment methods.Group A was treated with FURL and group B was treated with mPCNL combined with FURL.The perioperative related indexes of the two groups,the success rate of lithotripsy,renal function and the levels of serum interleukin-6(IL-6)and C-reactive protein(CRP)before and after operation,and the occurrence of complications were compared.Results The operation time,the postoperative hospital stay of group B were(136.2±12.8)min,(8.6±1.9)d,which were significantly longer than those of group A[(113.8±11.6)min,(5.8±1.5)d],the intraoperative blood loss of group B was(67.7±10.8)mL,which was more than that of group A[(26.9±9.5)mL],the differences were statistically significant(P<0.05).The success rate of lithotripsy in group B was 100%,which was significantly higher than that in group A(83.3%),the difference was statistically significant(P<0.05).The postoperative creatinine and urea nitrogen of group B were(78.95±9.12)μmol/L and(7.01±1.13)mmol/L,respectively,and group A were(77.34±8.91)μmol/L and(6.69±1.10)mmol/L,respectively.There was no significant difference in the levels of creatinine and urea nitrogen between the two groups after surgery(P>0.05).Postoperative serum IL-6 and CRP levels in group B were(16.82±1.71)ng/L and(22.72±3.55)mg/L,respectively,and group A were(17.54±1.44)ng/L and(23.67±4.01)mg/L,there was no statistically significant difference in postoperative serum IL-6 and CRP levels between the two groups(P>0.05).There was no significant difference in the incidence of complications between group A and group B(10.42%vs.6.25%,P>0.05).Conclusion MPCNL combined with FURL is effective and safe in the treatment of CRC,which can improve the success rate of lithotripsy and has little effect on renal function.