微创经皮肾镜取石术治疗肾积水合并肾结石的临床实践及结石清除率观察

Clinical Practice and Stone Clearance Rate of Minimally Invasive Percutaneous Nephrolithotomy in the Treatment of Nephrolithiasis Complicated with Renal Calculi

目的观察微创经皮肾镜取石术治疗肾积水合并肾结石的效果及结石清除率。方法选取2020年1月-2022年2月我院诊治的80例肾积水合并肾结石患者为研究对象,采用随机数字表法分为对照组和观察组,各40例。对照组采用常规尿路输尿管镜取石术治疗,观察组采用微创经皮肾镜取石术治疗,比较两组临床手术相关指标(手术时间、术中出血量、住院时间、住院费用)、结石清除率、疼痛(VAS)评分、炎性因子指标[C反应蛋白(CRP)、白细胞介素-6(IL-6)]水平、肾功能指标[血清肌酐(Scr)、半胱氨酸蛋白酶抑制剂C(Cys-C)]以及术后并发症发生率。结果观察组手术时间、住院时间短于对照组、术中出血量少于对照组、住院费用高于对照组(P<0.05);观察组结石清除率为92.50%,高于对照组的80.00%(P<0.05);两组术后2 h VAS评分比较,差异无统计学意义(P>0.05),而观察组术后12、24 h VAS评分低于对照组(P<0.05);两组术后24 h CRP、IL-6比较,差异无统计学意义(P>0.05);两组术后24 h Scr比较,差异无统计学意义(P>0.05),而观察组Cys-C高于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论微创经皮肾镜取石术治疗肾积水并肾结石可实现较理想的治疗效果,不仅可提高结石清除率、缩短手术和住院时间、减少术中出血量、减轻患者疼痛度、降低术后并发症发生几率,同时对肾功能损伤及炎症反应无明显影响。虽然住院费用相对提高,但具有以上优势,值得临床应用。

Objective To observe the effect and stone clearance rate of minimally invasive percutaneous nephrolithotomy in the treatment of nephrolithiasis complicated with renal calculi.Methods A total of 80 patients with nephrolithiasis complicated with renal calculi diagnosed and treated in our hospital from January 2020 to February 2022 were selected as the research objects.They were divided into control group and observation group by random number table method,with 40 patients in each group.The control group was treated with conventional ureteroscopic lithotripsy,and the observation group was treated with minimally invasive percutaneous nephrolithotomy.The clinical operation related indexes(operation time,intraoperative blood loss,hospitalization time,hospitalization cost),stone clearance rate,pain(VAS)score,inflammatory factor indexes[C-reactive protein(CRP),interleukin-6(IL-6)],renal function indexes[serum creatinine(Scr),cysteine protease inhibitor C(Cys-C)]and postoperative complication rate were compared between the two groups.Results The operation time and hospitalization time of the observation group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,and the hospitalization cost was higher than that of the control group(P<0.05).The stone clearance rate of the observation group was 92.50%,which was higher than 80.00%of the control group(P<0.05).There was no significant difference in VAS score between the two groups at 2 h after operation(P>0.05),while the VAS scores of the observation group at 12 and 24 h after operation were lower than those of the control group(P<0.05).There was no significant difference in CRP and IL-6 between the two groups at 24 h after operation(P>0.05).There was no significant difference in Scr 24 h after operation between the two groups(P>0.05),while Cys-C in the observation group was higher than that in the control group(P<0.05).The incidence of complications in the observation group was lower than that in the control group(P<0.05).Conclusion Minimally invasive percutaneous nephrolithotomy can achieve an ideal therapeutic effect in the treatment of nephrolithiasis complicated with renal calculi.It can not only improve the stone clearance rate,shorten the operation and hospitalization time,reduce the intraoperative blood loss,reduce the pain of patients,and reduce the incidence of postoperative complications,but also has no significant effect on renal function injury and inflammatory response.Although the hospitalization cost is relatively increased,it can realize the above application advantages and has clinical application value.