负压组合式输尿管镜联合输尿管软镜与经皮肾镜治疗复杂性肾结石的比较

Comparative analysis of combination of negative pressure ureteroscopy with flexible ureteroscopy and percutaneous nephrolithotomy in treatment of complex renal stones

目的比较负压组合式输尿管镜联合输尿管软镜与经皮肾镜处理复杂性肾结石的优劣性。方法回顾性收集2020年1月至2022年12月东莞市厚街医院复杂性肾结石患者的资料,根据结石大小1:1倾向性匹配后分为两组,各48例。研究组行负压组合式输尿管镜治疗,对照组行经皮肾镜治疗。比较两组结石大小、术后结石清除率、手术前后肾功能、血清炎症因子水平变化和术后并发症发生率。结果研究组与对照组比较,结石大小分别为[(23.9±2.9) mm vs (24.4±3.0) mm,P=0.399];结石清除率分别为95.83% vs 81.25%,P=0.025;术中出血量[(10.4±3.0) ml vs (61.2±10.1) ml,P<0.001];术后CRP两组分别为[(13.1±1.4) mg/L vs (16.5±1.5)mg/L,P<0.001];术后PCT为[(0.586±0.145) ng/ml vs (0.855±0.149)ng/ml,P<0.001];围手术期总并发症发生率4.17% vs 22.92%,P=0.025,但研究组有1例发生输尿管损伤,放置输尿管支架管痊愈。术后随访1年,研究组没有发生输尿管狭窄。结论负压组合式输尿管镜联合输尿管软镜治疗复杂性肾结石可提升结石清除率,减轻手术引起的炎性反应,降低肾脏的损伤,并发症少,疗效优于经皮肾镜。

ObjectiveTo compare the effects of ureteroscopy with negative pressure suction combined with flexible ureteroscopy and percutaneous nephrolithotomy for the treatment of complex renal stones.MethodsThe data of patients with complex kidney stones in Houjie Hospital of Dongguan from January 2020 to December 2022 were retrospectively collected, and were divided into two groups with 48 cases each after 1:1 propensity score matching of stone size. The study group underwent ureteroscopy with negative pressure suction combined with flexible ureteroscopy, while the control group underwent percutaneous nephrolithotomy. The comparison included assessments of stone diameter, postoperative stone clearance rate, pre- and postoperative renal function, changes in serum inflammatory factor levels, and postoperative complication rates.ResultsComparison between the study group and the control group: The stone diameter was (23.9±2.9) mm vs (24.4±3.0) mm, P=0.399;the stone clearance rate was 95.83% vs 81.25%, P=0.025;the intraoperative blood loss was (10.4±3.0) ml vs (61.2±10.1) ml, P<0.001;the postoperative CRP level was (13.1±1.4) mg/L vs (16.5±1.5) mg/L, P<0.001;the postoperative PCT level was (0.586±0.145) ng/ml vs (0.855±0.149) ng/ml, P<0.001;the total perioperative complication rate was 4.17% in the study group and 22.92% in the control group, P=0.025, with 1 case of ureteral injury in the study group, which recovered after placement of a ureteral stent. One-year postoperative follow-up revealed no cases of ureteral stricture in the study group.ConclusionsThe combination of ureteroscopy with negative pressure suction and flexible ureteroscopy for the treatment of complex renal stones improved stone clearance rates, reduced surgery-induced inflammatory reactions, minimized kidney damage, and resulted in fewer complications. The efficacy was superior to that of percutaneous nephrolithotomy.