微通道与标准通道经皮肾镜取石术治疗肾结石的临床疗效及安全性分析

Clinical efficacy and safety analysis of microchannel and standard channel percutaneous nephrolithotomy in the treatment of kidney stones

目的探讨微通道经皮肾镜取石术(MPCNL)与标准通道经皮肾镜取石术(PCNL)治疗肾结石的临床疗效及安全性。方法选取2019年1月至2022年1月赤壁市蒲纺医院收治的120例肾结石患者作为研究对象,根据随机数字表法分为对照组与观察组,每组60例。对照组给予PCNL治疗,观察组给予MPCNL治疗,比较两组一期结石清除率、手术指标、肾血流动力学指标、血清炎症指标及并发症发生率。结果观察组一期结石清除率(93.33%)高于对照组(70.00%),差异有统计学意义(P<0.05)。观察组术中出血量少于对照组,观察组手术时间、术后首次下床时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。术后1周,两组阻力指数(RI)均低于术前,肾主动脉收缩期峰值(Vmax)均高于术前,观察组收缩期峰值/舒张期流速(S/D)值低于术前,对照组S/D值高于术前,且观察组RI、S/D值均低于对照组,Vmax高于对照组,差异有统计学意义(P<0.05)。术后1周,两组血清C反应蛋白(CRP)水平、WBC均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05)。观察组并发症发生率(3.33%)低于对照组(18.33%),差异有统计学意义(P<0.05)。结论与PCNL比较,MPCNL治疗肾结石的创伤性更小,可有效改善患者肾脏血流动力学,促进患者术后恢复,降低并发症发生率。

Objective To investigate the clinical efficacy and safety of microchannel percutaneous nephrolithotomy(MPCNL)and standard channel percutaneous nephrolithotomy(PCNL)in the treatment of kidney stones.Methods A total of 120 patients with kidney stones admitted to Pu-fang Hospital of Chibi City from January 2019 to January 2022 were selected as the study subjects,and they were divided into the control group and the observation group according to the random number table method,with 60 cases in each group.The control group was treated with PCNL and the observation group was treated with MPCNL,the first-stage stone clearance rate,surgical indexes,renal hemodynamic indexes,serum inflammatory indexes and the incidence of complications were compared between the two groups.Results The first-stage stone clearance rate in the observation group(93.33%)was higher than that in the control group(70.00%),and the difference was statistically significant(P<0.05).The amount of intraop-erative blood loss in the observation group was less than that in the control group,and the operation time,the first time of getting out of bed after sur-gery and the length of hospital stay in the observation group were shorter than those in the control group,and the differences were statistically signifi-cant(P<0.05).1 week after operation,the resistance index(RI)of the two groups were lower than those before operation,and the renal aortic systol-ic peak value(Vmax)of the two groups were higher than that before operation,and systolic peak/diastolic flow rate(S/D)value in the observation group was lower than that before operation,S/D in the control group was higher than before operation,and RI,S/D value in the observation group were lower than those in the control group,and Vmax was higher than that in the control group,and the differences were statistically significant(P<0.05).1 week after operation,the serum C-reactive protein(CRP)level and WBC of the two groups were higher than those before operation,but the observa-tion group was lower than the control group,and the differences were statistically significant(P<0.05).The incidence of complications in the observa-tion group(3.33%)was lower than that in the control group(18.33%),and the difference was statistically significant(P<0.05).Conclusion Com-pared with PCNL,MPCNL is less traumatic in the treatment of kidney stones,and can effectively improve the renal hemodynamics of patients,pro-mote postoperative recovery and reduce the complication rate.