输尿管软镜碎石术与微通道经皮肾镜碎石术治疗老年肾结石疗效对比分析

Comparative analysis of the efficacy of flexible ureteroscopic lithotripsy and micro-channel percutaneous nephrolithotomy in the treatment of kidney stones in the elderly

目的 探讨输尿管软镜碎石术(FUL)与微通道经皮肾镜碎石术(MPCNL)治疗老年肾结石患者的效果差异。方法 我院收治的118例老年肾结石患者,按随机数字表法分为FUL组60例和MPCNL组58例,FUL组实施FUL治疗,MPCNL组实施MPCNL治疗。比较两组围术期指标[血红蛋白(Hb)下降水平、碎石时间、手术耗时、住院时间]、结石清除率、疼痛度[视觉模拟疼痛评分(VAS)]、肾功能[尿肌酐(UCr)、尿素氮(BUN)、血尿酸(BUA)]、并发症总发生率、肾结石复发率。结果 FUL组Hb下降水平、住院时间低于MPCNL组;碎石时间、手术耗时高于MPCNL组(P<0.05);两组结石清除率比较差异无统计学意义(P>0.05)。FUL组术后1、5、12、24 h时VAS评分均低于MPCNL组(P<0.05)。与术前比较,两组术后3 d时BUN水平无明显变化(P>0.05),UCr水平升高,BUA水平降低(P<0.05),两组间比较差异无统计学意义(P>0.05)。两组围术期及术后并发症总发生率比较差异无统计学意义(P>0.05)。术后6个月内两组肾结石复发率比较差异无统计学意义(P>0.05)。结论 FUL、MPCNL治疗老年肾结石患者疗效相近,但FUL具有创伤小、患者术后恢复快等优点,临床可将其作为优先选择方案。

Objective To investigate the differences in effects between flexible ureteroscopic lithotripsy(FUL)and microchannel percutaneous nephrolithotomy(MPCNL)in the treatment of elderly patients with renal stones.Methods One hundred and eighteen elderly patients with renal stones in our hospital were selected.The patients were divided into a FUL group(n=60)and a MPCNL group(n=58)by using random number table method.The FUL group received FUL treatment while the MPCNL group was given MPCNL treatment.Perioperative indicators such as decreased hemoglobin(Hb)level,lithotripsy time,surgical time and hospital stay,stone clearance rate,pain degree estimated by Visual Analogue Score(VAS),renal function such as urine creatinine(UCr),blood uric acid(BUA)and blood urea nitrogen(BUN),total incidence rate of complications and recurrence rate of renal stones were compared between the two groups.Results The Hb decline level and hospital stay in the FUL group were significantly lower or shorter than those in the MPCNL group(P<0.05).The lithotripsy time and surgical time were significantly longer in the FUL group than those in the MPCNL group(P<0.05).There was no significant difference in the stone clearance rate between the two groups(P>0.05).Compared with the MPCNL group,the VAS scores of patients at 1 hour,5,12 and 24 hours after surgery were markedly lower in the FUL group(P<0.05).The BUN level in both groups after 3 days of surgery was not significantly different from that before surgery(P>0.05).However,the level of UCr was significantly enhanced(P<0.05)while the level of BUA was significantly reduced after 3 days of surgery when compared to before surgery(P<0.05).However,there was no significant difference in the levels of UCr and BUA between the two groups(P>0.05).There was no significant dfference in the total incidence rate of perioperative and postoperative complications during perioperative period and after surgery(P>0.05).The dfference in the recurrence rate of renal stones was not evident within 6 months after surgery between the two groups(P>0.05).Conclusions FUL and MPCNL have similar efficacy in the treatment of elderly patients with renal stones,However,FUL has the advantages of smaller trauma and quicker postoperative recovery.Therefore,it can be used as a preferred option in clinical practice.