超声引导下针状肾镜联合标准通道与多通道经皮肾镜碎石术治疗肾结石的临床效果对比

Comparison of the clinical effects of ultrasound-guided needle nephroscopy combined with standard-channel versus multi-channel percutaneous nephrolithotomy for treating renal calculus

目的对比经超声引导下针状肾镜联合标准通道与多通道经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)治疗肾结石的疗效。方法回顾性分析2022年8月至2023年9月昭通市第一人民医院收治的94例肾结石患者的临床资料,根据术中采用不同的通道分为对照组(n=44)和观察组(n=50),分别采取超声引导下多通道PCNL和超声引导下针状肾镜联合标准通道PCNL。对比两组手术相关指标、术前及术后24 h炎症指标、氧化应激指标、结石清除率、术后并发症发生率。结果观察组术中出血量少于对照组,手术时间和住院时间均短于对照组,差异有统计学意义(P<0.05);术后24 h,两组白细胞介素-10(interleukin-10,IL-10)、超敏C-反应蛋白(high sensitivity C-reactive protein,hs-CRP)、降钙素原(procalcitonin,PCT)水平升高,血红蛋白(hemoglobin,Hb)、超氧化物歧化酶(superoxide dismutase,SOD)、谷胱甘肽过氧化物酶(glutathione peroxidase,GSH-Px)水平下降,但观察组IL-10、hs-CRP、PCT水平升高幅度及Hb、SOD、GSH-Px水平降低幅度小于对照组,差异有统计学意义(P<0.05);两组结石清除率比较(94.00%vs.97.73%),差异无统计学意义(P>0.05);观察组(10.00%)并发症发生率低于对照组(27.27%),差异有统计学意义(P<0.05)。结论超声引导下多通道PCNL和超声引导下针状肾镜联合标准通道PCNL治疗肾结石的临床疗效相当,但后者在降低患者术后炎症应激反应和并发症发生率方面效果更为理想。

Objective To compare the clinical effects of ultrasound-guided needle nephroscopy combined with standard channel and multi-channel percutaneous nephrolithotomy(PCNL)in the treatment of renal calculus.Methods The clinical data of 94 patients with renal calculus admitted to the Zhaotong First People's Hospital from August 2022 to September 2023 were retrospectively analyzed,and they were divided into control group(44 cases)and observation group(50 cases)according to the different channels used during the operation.Ultrasound-guided multi-channel PCNL was used for the control group while ultrasound-guided needle nephroscope combined with standard channel PCNL was used for the observation group.The two groups were compared in terms of surgery-related indexes,preoperative and postoperative levels at 24 hours,inflammation indexes,oxidative stress indexes,stone clearance rate,and postoperative complication rate.Results The intraoperative blood loss in the observation group was lower than that in the control group,and the operation time and hospital stay were shorter than those in the control group(P<0.05);24 hours after surgery,the 2 groups had elevated levels of interleukin-10(IL-10),high sensit ivity C-reactive protein(hs-CRP),and procalcitionin(PCT),and decreased levels of hemoglobin(Hb),superoxide dismutase(SOD),and glutathioneperoxi dase(GSH-Px),but the above indexes in the observation group changed slightly(P<0.05).Comparison of stone clearance rate between the two groups(94.00%vs.97.73%)(P>0.05),but the complication rate of the the control group(27.27%)was higher than that of the observation group(10.00%)(P<0.05).Conclusion The clinical efficacy of ultrasound-guided multichannel PCNL and ultrasound-guided needle nephroscopy combined with standard-channel PCNL in the treatment of renal calculus is comparable,but the latter is more effective in reducing postoperative inflammatory stress and complication rates.