微通道经皮肾镜取石术联合FURL治疗复杂肾结石患者的效果观察

Effect of Mini-percutaneous Nephrolithotomy Combined with FURL in the Treatment of Complex Renal Calculi

目的总结复杂性肾结石(Complex Renal Calculi,CRC)患者的手术治疗方法,对单独应用输尿管软镜碎石术(Flexible Ureteroscopic Lithotripsy,FURL)与微通道经皮肾镜取石术(Mini-Percutaneous Nephrolithotomy,MPCNL)联合FURL的临床价值进行比较。方法回顾性选取2022年11月—2023年10月贵州省大方县人民医院收治的86例CRC患者的临床资料,根据手术治疗方案的差异性进行分组,单纯采取FURL治疗的43例患者为对照组,FURL与MPCNL联合应用的43例患者为观察组,比较两组碎石效果、手术相关指标、术后血肌酐与尿素氮变化、并发症情况。结果观察组一次碎石率为97.67%(42/43),高于对照组为81.40%(35/43),差异有统计学意义(χ^(2)=6.081,P=0.014)。观察组手术时间、术中出血量稍大于对照组,差异有统计学意义(P均<0.05)。两组住院时间及并发症总发生率比较,差异无统计学意义(P均>0.05)。与术前比较,两组术后血肌酐、尿素氮水平均有小幅度升高趋势,但差异无统计学意义(P均>0.05)。结论在CRC患者中,FURL与MPCNL联合治疗的效果显著,具有较高的碎石成功率与较好的安全性,且术后患者肾功能受到的影响较小。

Objective To summarize the surgical treatment of patients with complex renal calculi(CRC)and compare the clinical value of flexible ureteroscopic lithotripsy(FURL)alone with mini-percutaneous nephrolithotomy(MPCNL)combined with FURL.Methods Clinical data of 86 CRC patients admitted to Dafang County People's Hospital from November 2022 to October 2023 were retrospectively selected,and the patients were grouped according to differences in surgical treatment plans.Forty-three patients treated with FURL alone were the control group,and forty-three pa⁃tients treated with FURL combined with MPCNL were the observation group.The effects of lithotripsy,operative re⁃lated indexes,postoperative changes of serum creatinine and urea nitrogen,and complications were compared between the two groups.Results The primary lithotomy rate was 97.67%(42/43)in the observation group,which was higher than that in the control group 81.40%(35/43),and the difference were statistically significant(χ^(2)=6.081,P=0.014).The operation time and blood loss in the observation group were slightly longer than those in the control group,and the differences were statistically significant(both P<0.05).There were no statistically significant differences in length of stay and incidence of complications between the two groups(both P>0.05).Compared with pre-operation,serum cre⁃atinine and urea nitrogen in both groups had a slight increase trend after operation,but the differences were not statis⁃tically significant(both P>0.05).Conclusion In CRC patients,FURL and MPCNL combined therapy has a significant effect,with a high success rate of lithotripsy and a good safety,and the postoperative renal function of patients is less affected.