双镜联合手术治疗上尿路结石的临床观察

Clinical observation of double-endoscopy combined operation in the treatment of upper urinary tract calculi

目的:探讨输尿管软镜钬激光碎石术(FURSL)结合微通道经皮肾镜取石术(mPCNL)治疗上尿路结石的临床疗效。方法:选取2018年9月至2021年9月收治的126例上尿路结石患者,按随机数字表法分为3组,FURSL组(n=42)行FURSL,mPCNL组(n=42)行mPCNL,联合组(n=42)行FURSL联合mPCNL。统计3组手术及并发症情况,术前、术后均检测血流动力学指标、肾功能指标。结果:FURSL组与mPCNL组相比,术中出血量少,手术时间长,住院时间短(P<0.05);联合组与FURSL组相比,术中出血量多,手术时间短,住院时间长,术后3 d结石清除率高(P<0.05);联合组与mPCNL组相比,术中出血量少,住院时间短,术后3 d结石清除率高(P<0.05),手术时间与mPCNL组差异无统计学意义(P>0.05)。术后各组中心静脉压、平均动脉压、心率与同组术前相比差异无统计学意义(P>0.05),β2-微球蛋白、血肌酐、尿素氮均高于同组术前(P<0.05)。3组并发症总发生率差异无统计学意义(P>0.05)。结论:FURSL结合mPCNL治疗上尿路结石具有良好的临床疗效及较高的安全性。

Objective:To investigate the clinical efficacy of flexible ureteroscope lithotripsy(FURSL)combined with minimally invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper urinary tract calculi.Methods:From Sep.2018 to Sep.2021,126 patients with upper urinary tract calculi were divided into three groups according to the random number table.The FURSL group(n=42)was given FURSL,the mPCNL group(n=42)underwent mPCNL,and the combination group(n=42)received FURSL combined with mPCNL.The surgical situation and complications of the three groups were counted,the hemodynamic indicators and renal function indicators were tested before and after surgery.Results:The intraoperative blood loss of the FURSL group was less than that of the mPCNL group,the operation time was longer than that of the mPCNL group,and the hospital stay was shorter than that of the mPCNL group(P<0.05).The intraoperative blood loss of the combined group was more than that of the FURSL group,the ope-ration time was shorter than that of the FURSL group,the hospitalization time was longer than that of the FURSL group,and the stone clearance rate was higher than that of the FURSL group at 3 d after surgery(P<0.05);the intraoperative blood loss of the combined group was less than that of the mPCNL group,the hospital stay was shorter than that of the mPCNL group,and the stone clearance rate at 3 d after surgery was higher than that of the mPCNL group(P<0.05),there was no significant difference in operation time between the combined group and mPCNL group(P>0.05).The central venous pressure,mean arterial pressure and heart rate of each group a fter the operation were not statistically different from those of the same group before the operation(P>0.05).Theβ2-microglobulin,serum creatinine and blood urea nitrogen of each group after operation were higher than those of the same group before the operation(P<0.05).The difference of the total incidence of complications in the three groups was not statistically significant(P>0.05).Conclusions:FURSL combined with mPCNL has a promising curative effect and high safety in the treatment of upper urinary tract calculi.