负压清石技术联合肾上盏穿刺在经皮肾镜取石术中的应用

Application of negative pressure lithotomy combined with renal upper calyceal puncture in percutaneous nephrolithotomy

目的探讨负压清石技术联合肾上盏穿刺在经皮肾镜取石术(PCNL)中的应用效果。方法选取2019年9月至2021年8月在咸阳市第一人民医院行PCNL手术中结石负荷接近的86例患者作为研究对象,采用随机数字表法将患者分为观察组和对照组,每组各43例。观察组于PCNL手术中应用负压清石技术联合肾上盏穿刺,对照组于PCNL手术中应用常规的可撕开鞘经肾中盏或肾下盏穿刺。比较两组患者的围手术期相关指标、肾功能和氧化应激相关指标及术中、术后并发症发生情况。结果观察组的手术时间、术中出血量、清石时间、术中肾盂内压力及术后住院时间均较对照组显著降低,结石清除率较对照组升高(均P<0.05)。术后7 d两组血清肌酐(Scr)、尿素氮(BUN)、皮质醇(COR)及去甲肾上腺素(NE)等肾功能及氧化应激指标水平均较术前升高(均P<0.05),且观察组的各肾功能及氧化应激指标水平均明显低于对照组(均P<0.05)。观察组术中、术后的总并发症发生率与对照组比较,差异均无统计学意义(均P>0.05)。结论在PCNL手术中应用负压清石技术联合肾上盏穿刺不仅能够有效地缩短手术时间,降低术中损伤及肾盂内压力,提高结石清除率,还可有效减轻患者的肾损伤及氧化应激反应,且有降低并发症发生的趋势,更有利于患者的术后恢复。

Objective To investigate the application effect of negative pressure lithotomy combined with renal upper calyx puncture in percutaneous nephrolithotomy(PCNL).Methods A total of 86 patients with close calculi load in PCNL in Xianyang First People′s Hospital from September 2019 to August 2021 were selected as the study objects.Patients were divided into observation group and control group by random number table method,with 43 cases in each group.The observation group was treated with negative pressure lithotomy combined with renal upper calyceal puncture during PCNL operation,while the control group was treated with conventional tear sheath puncture through renal middle or lower calyceal puncture.The perioperative related indexes,renal function and oxidative stress related indexes and the occurrence of intraoperative and postoperative complications were compared between the two groups.Results The operative time,intraoperative blood loss,intraoperative stone removal time,intraoperative renal pelvis pressure and postoperative hospital stay were significantly reduced in the observation group compared with the control group,and the stone clearance rate was significantly increased(all P<0.05).The levels of renal function and oxidative stress indexes such as serum creatinine(Scr),urea nitrogen(BUN),cortisol(COR)and norepinephrine(NE)in both groups were significantly increased 7 days after surgery compared with those before surgery(all P<0.05),and the levels of renal function and oxidative stress indexes in the observation group were significantly lower than those in the control group(all P<0.05).There was no significant difference in the incidence of intraoperative and postoperative complications between the observation group and the control group(all P>0.05).Conclusions The application of negative pressure lithotomy combined with renal upper calyceal puncture in PCNL can not only effectively shorten the operation time,reduce intraoperative injury and intrarenal pelvis pressure,improve the lithotomy rate,but also effectively reduce the kidney injury and oxidative stress reaction of patients,and has a tendency to reduce the occurrence of complications,which is more conducive to the postoperative recovery of patients.