微通道经皮肾镜碎石术与负压组合式输尿管镜碎石术治疗老年输尿管下段结石并发肾感染的疗效

The therapeutic effect of micro-channel percutaneous nephrolithotomy combined with negative pressure ureteroscopic lithotripsy in the treatment of senile distal ureteral calculi complicated with renal infection

目的观察微通道经皮肾镜碎石术与负压组合式输尿管镜碎石术治疗老年输尿管下段结石(DUC)并发肾感染(RI)的疗效。方法选取2019年3月至2021年3月在湖北六七二中西医结合骨科医院确诊的132例老年输尿管下段结石并发肾感染患者的临床资料进行回顾性分析,根据手术术式的不同将患者分为观察组(n=59)和对照组(n=73)。对照组患者采用微通道经皮肾镜碎石术治疗,观察组采用负压组合式输尿管镜碎石术治疗。比较两组患者的手术相关情况(手术时间、手术出血量、住院时间)和临床疗效(结石清除率、感染症状发生情况和细菌阳性检测率)以及术后非感染并发症的发生情况。结果观察组手术出血量和住院时间明显低于对照组(P<0.05)。两组患者结石清除率差异无统计学意义(P>0.05);观察组感染性症状发生率和细菌阳性检测率明显低于对照组,差异有统计学意义(P<0.05)。观察组非感染性并发症总发生率(5.08%)低于对照组(16.44%),差异有统计学意义(P<0.05)。结论负压组合式输尿管镜碎石术与微通道经皮肾镜碎石术相比较,临床疗效均确切,但在手术创伤、术后并发症以及预后恢复方面前者更具优势。

Objective To observe the curative effect of micro-channel percutaneous nephrolithotomy(PCNL)combined with negative pressure ureteroscopic lithotripsy in the treatment of elderly patients with distal ureteral calculi(DUC)complicated with renal infection(RI).Methods The clinical data of 132 elderly patients with DUC complicated with RI diagnosed in Hubei 672 Orthopaedics Hospital of Integrated Chinese and Western Medicine from March 2019 to March 2021 were analyzed retrospectively,and the patients were divided into the observation group(n=59)and the.control group(n=73)according to different surgical methods.Patients in control group were treated with micro-channel PCNL,while patients in observation group were treated with negative pressure combined ureteroscopic lithotripsy.The operation-related conditions(operation time,blood loss and hospital stay),clinical efficacy(stone clearance rate,infection symptoms and bacterial positive detection rate)and postoperative non-infection complications were compared between the two.groups.Results The bleeding volume and hospital stay in the observation group were significantly lower than those in the control group(P<0.05).There was no significant difference in stone clearance rate between the two groups(P>0.05).The incidence of infectious symptoms and positive detection rate of bacteria in the observation group were significantly lower than those in the control group,with statistically significant differences(P<0.05).The total incidence of non-infectious complication rate in the observation group(5.08%)was lower than that in the control group(16.44%),with statistically significant difference(P<0.05).Conclusion Compared with micro-channel PCNL,they all have exact clinical efficacy,but the former has more advantages in surgical trauma,postoperative complications and prognosis recovery.