无管化可视超细经皮肾镜碎石术治疗肾结石患者的临床研究

Clinical study of tubeless visual super-mini percutaneous nephrolithotomy in the treatment of patients with renal calculi

目的研究无管化可视超细经皮肾镜碎石术治疗肾结石患者的安全性及临床疗效。方法选取2018年5月至2020年9月在本院采用可视超细经皮肾镜碎石术治疗的180例肾结石患者为研究对象,随机将患者分为标准组(90例)和无管化组(90例)。标准组术后留置双J管及肾造瘘管;无管化组术后留置制造人工肾积水的输尿管导管1 d,不留置双J管及肾造瘘管。比较两组患者的手术时间、术后血红蛋白下降值、术后住院时间、医疗总费用、结石清除率、双J管相关并发症发生情况等,并分析两种术式对患者生活质量的影响。结果两组结石清除率(91.11%vs.88.89%)、术后血红蛋白下降值[(11.65±2.74)g/L vs.(12.48±3.26)g/L]比较,差异均无统计学意义(均P>0.05)。无管化组的手术时间、术后住院时间、医疗总费用均低于标准组(均P<0.05)。无管化组术后第7天及术1个月的VAS评分及肉眼血尿、膀胱刺激征发生例数均低于标准组(均P<0.05)。无管化组的威斯康星州结石生活质量问卷(WISQOL)评分差值高于标准组(P<0.05)。结论无管化可视超细经皮肾碎石术在肾结石治疗中同样安全有效,其创伤小、术后并发症少,可明显改善患者的生活质量,值得临床推广。

Objective To investigate the safety and efficacy of tubeless visualized super-mini percutaneous nephrolithotomy in the treatment of patients with renal calculi.Methods A total of 180 patients with kidney stones who were treated by visual ultra-fine percutaneous nephrolithotripsy in our hospital from May 2018 to September 2020 were selected as the study objects,and were randomly divided into standard group(90 cases)and tube-free group(90 cases).Double-J tubes and nephrostomy tubes were indwelled in the standard group,and ureteral catheter for artificial hydronephrosis was indwelled for 1 day in the non-catheterized group.The operation time,postoperative hemoglobin decline value,postoperative hospital stay,total medical cost,stone clearance rate,double-J tube related complications were compared between the two groups,and the effects of the two surgical methods on the quality of life were analyzed.Results There were no significant differences in stone clearance rate(91.11%vs.88.89%)and postoperative hemoglobin reduction value[(11.65±2.74)g/L vs.(12.48±3.26)g/L]between two groups(all P>0.05).The operation time,postoperative hospital stay and total medical expenses in the no-tube group were lower than those in the standard group(all P<0.05).The difference of wisconsin stone quality of life questionnaire(WISQOL)score in the tube-free group was significantly higher than that in the standard group(P<0.05).Conclusions Tubeless visual ultra-fine percutaneous nephrolithotripsy is also safe and effective in the treatment of kidney stones,with less trauma and postoperative complications,and can significantly improve the quality of life of patients,which is worthy of clinical application.