Comparison of the Effects of Minimally Invasive Percutaneous Nephrolithotomy and Open Surgery on Kidney Stones

Objective:To compare the treatment effects of minimally invasive percutaneous nephrolithotomy and open surgery on kidney stones.Methods:From November 2018 to November 2019,80 patients with kidney stones who were treated in our hospital were selected and divided into two groups according to the random number table method.Each group contained 40 patients.The patients in control group were treated with open surgery while the patients in observation group were treated with minimally invasive percutaneous nephrolithotomy.The surgical indicators,rate of stone removal,and adverse events were compared between the two groups.Results:There was no statistically significant difference in surgical time between the two groups(P>0.05).Compared with the control group,the observation group had less intraoperative blood loss and shorter hospital stay,and the differences were statistically significant(P<0.05).The stone clearance rate(95.00%)in the observation group was higher than that in the control group(77.50%),and the difference was statistically significant(P<0.05).Compared with the control group,the incidence of postoperative adverse effects was lower in the observation group,and the difference was statistically significant(P<0.05).Conclusion:Minimally invasive percutaneous nephrolithotomy for kidney stones is effective in reducing the intraoperative blood loss,shortening the length of hospital stay,improving the rate of stone clearance and reducing the occurrence of adverse effects.Therefore,this treatment method should be promoted for clinical use.

Effect of Humanistic Nursing Care on Health Knowledge Mastery and Nursing Satisfaction Among Patients Undergoing Kidney Stone Surgery

Objective:To deeply understand the influence of humanistic nursing care on the health knowledge mastery and nursing satisfaction among patients undergoing kidney stone surgery.Methods:Sixty patients with kidney stone who underwent surgical treatment in our hospital from June 2019 to June 2020 were randomly divided into reference group and experimental group by random number table method.There were 30 patients in each group.The patients of reference group were given routine nursing care,and the patients of experimental groups were given humanistic nursing care.The mastery score of various health knowledge,nursing satisfaction and postoperative complications were compared between the two groups.Results:The scores of health knowledge mastery among the patients in experimental group who were treated with humanistic nursing care were much higher than those in reference group who were treated with routine nursing care.The nursing satisfaction of patients in experimental group(96.67%)was significantly higher than that in reference group(80.00%),and the incidence of complications after kidney stone surgery in the experimental group(6.67%)was higher than that in the reference group(26.67%)(P<0.05).Conclusion:Humanistic nursing care is greatly conducive to the mastery of health knowledge in patients undergoing kidney stone surgery,and this nursing mode can meet the needs for nursing work and potentially minimize postoperative complications.

Retrograde intrarenal surgery vs miniaturized percutaneous nephrolithotomy to treat lower pole renal stones 1.5-2.5 cm in diameter

AIM To compare the outcomes of retrograde intrarenal surgery(RIRS) and miniaturized percutaneous nephrolithotomy(mini-PCNL) in treating lower pole(LP) renal stones with a diameter of 1.5-2.5 cm.METHODS A total of 216 patients who underwent mini-PCNL(n = 103) or RIRS n = 113) for LP stones with a diameter of 1.5-2.5 cm were enrolled between December 2015 and April 2017 at the Urology Department of Ningbo Urology and Nephrology Hospital.RESULTS Significant differences were found in the hospital stay(9.39 ± 4.01 vs 14.08 ± 5.26, P < 0.0001) and hospitalization costs(2624.5 ± 513.36 vs 3255.2 ± 976.5, P < 0.0001) between the RIRS and mini-PCNL groups. The mean operation time was not significantly different between the RIRS group(56.48 ± 24.77) and the mini-PCNL group(60.04 ± 30.38, P = 0.345). The stone-free rates at the first postoperative day(RIRS vs mini-PCNL: 90.2% vs 93.2%, P = 0.822) and the second month postoperatively(RIRS vs mini-PCNL: 93.8% vs 95.1%, P = 0.986) were not significantly different.CONCLUSION RIRS and mini-PCNL are both safe and effective methods for treating LP stones with a diameter of 1.5-2.5 cm. RIRS can be considered as an alternative to PCNL for the treatment for LP stones of 1.5-2.5 cm.

Kidney stones over 2 cm in diameter-between guidelines and individual approach

The prevalence of urolithiasis has been observed to increase during last decades. Kidney stones over 2 cm in diameter are the common urologic problem. European and American Associations of Urology has published guidelines on Urolithiasis and presented the most effective tools to treat large stones. On the other hand many experienced endourologic centres choose other modalities from their armamentarium. All treatment methods are characterized by their efficacy and safety which are usually inversely proportional. It is crucial for patients and physicians to find a golden mean. Percutaneous lithotripsy is still considered treatment of choice with more than 95% efficacy. Less invasive retrograde intrarenal surgery is also less effective, but burdened with lower complication rate. Extracorporeal shockwave lithotripsy is feasible in paediatric patients with acceptable stone free rates. Open surgery(pylolithotomy and anatrophic nephrolithotomy) are almost obsolete techniques. All methods have their pros and cons. Physicians should share decisions regarding treatment modalities with patients.

Effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on the levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi

Objective: To investigate the effect of flexible ureteroscope lithotripsy and percutaneous nephrolithotomy on levels of serum inflammatory factors, oxidative stress and stress hormone in patients with renal calculi. Methods: A total of 97 cases of renal calculi patients were chosen as the research objects, based on the random data table, they were divided into the control group (n=49) and the observation group (n=48), patients in the control group underwent percutaneous nephrolithotomy (PCNL) treatment, while the observation group patients were treated with flexible ureteroscope lithotripsy (FURL), before and after 1 d ,the levels of inflammatory factors [interleukin-10 (IL-10), C reactive protein (CRP), white blood cell (WBC)], stress hormone [cortisol (COR), adrenocorticotropic hormone (ACTH), norepinephrine (NE)] and oxidative stress [malondialdehyde (MDA), superoxide dismutase (SOD) ] of the two groups were compared. Results: There were no significant differences in IL-10, CRP, WBC, COR, ACTH, NE, MDA and SOD levels between the two groups preoperative;Compared with the preoperative level in the group, the 1 d post-operation levels of IL-10, CRP, WBC, COR, ACTH, NE and MDA in the two groups were significantly increased, and the level of the observation group was significantly lower than that in the control group;The levels of SOD in the two groups 1 d post-operation were significantly lower than those in the same group preoperative, and the control group (85.65±9.95) U/mL was significantly lower than that of the control group (94.71±7.63) U/mL. Conclusion: Compared with percutaneous nephrolithotomy, flexible ureteroscopic lithotripsy for renal calculi is less stressful and more favorable for postoperative recovery, has an important clinical value.

个体化护理在肾结石患者经皮肾镜超声碎石术中的作用

目的:分析个体化护理在肾结石患者经皮肾镜超声碎石术中的作用。方法:选取2022年1—12月麻城市人民医院拟行经皮肾镜超声碎石术的肾结石患者70例作为研究对象,采用随机数字表法分为对照组与观察组,各35例。对照组实施围术期常规护理,观察组在对照组基础上实施个体化护理。比较两组护理效果、术后恢复情况、心理状态、并发症发生情况、满意度。结果:观察组护理总有效率高于对照组,差异有统计学意义(P=0.022);观察组下床活动时间、拔管时间早于对照组,住院时间短于对照组,差异有统计学意义(P<0.05);护理后,两组汉密尔顿焦虑量表、汉密尔顿抑郁量表评分低于护理前,且观察组低于对照组,差异有统计学意义(P<0.05);观察组并发症总发生率低于对照组,差异有统计学意义(P=0.014)。观察组护理总满意度高于对照组,差异有统计学意义(P=0.029)。结论:个体化护理在肾结石患者经皮肾镜超声碎石术中的作用显著,可加快患者康复速度,改善心理状态,降低并发症发生率,提高护理满意度。

经输尿管软镜钬激光碎石术治疗上尿路结石的效果研究

目的探讨上尿路结石患者经输尿管软镜钬激光碎石术的治疗效果。方法选取2021年1月—2023年12月黔东南州人民医院泌尿外科接受治疗的上尿路结石患者90例,按治疗方法不同分为对照组与观察组,各45例。对照组患者应用经皮肾镜碎石术治疗,观察组患者应用经输尿管软镜钬激光碎石术治疗,对比2组患者的临床治疗效果。结果观察组患者的结石清除率为97.78%,高于对照组的84.44%(P<0.05)。观察组结石复发率为0,低于对照组的8.89%(P<0.05)。与对照组患者相比,观察组患者的手术治疗指标与疼痛评分情况均相对优良,手术时间为(55.53±4.27)min,短于对照组的(76.29±4.84)min;住院时间为(6.07±1.32)d,短于对照组的(9.35±1.50)d;术中出血量为(17.66±2.25)mL,少于对照组的(46.68±2.27)mL;在术后的肾功能改善情况明显,中性粒细胞明胶酶相关脂质运载蛋白(neutropil gelatinaseassociated lipocalin,NGAL)水平为(5.48±1.16)μg/L,低于对照组的(7.32±1.21)μg/L;血肌酐(serumcreatinine,Scr)水平为(67.33±7.85)μmol/L,低于对照组的(75.84±8.97)μmol/L;胱抑素C(cystatinC,CysC)水平为(525.92±81.34)μg/L,低于对照组的(633.69±70.48)μg/L(P<0.05)。观察组炎症数据指标数值相对较低,并发症发生率为4.44%,低于对照组的28.89%(P<0.05)。结论在上尿路结石患者的临床治疗中应用经输尿管软镜钬激光碎石术具有较为优良的效果,安全性与可靠性均相对较高。可有效改善患者的临床手术指标情况,可降低患者疼痛感的优势。该治疗方案还可有效改善患者的肾功能情况,且术后的复发率较低。

围手术期护理干预在微创经皮输尿管镜钬激光碎石术治疗肾结石老年患者中的效果观察

目的探索肾结石老年患者开展微创经皮输尿管镜钬激光碎石术围手术期护理干预对于术后康复效果。方法研究以我院收治的微创经皮输尿管镜钬激光碎石术治疗的老年肾结石患者作为研究样本,样本量132例,时间线截取2021年1月—2023年9月,按照信封抽签方式将患者抽取为两组,对照组开展常规护理,观察组开展围手术期护理干预,观察各项指标变化。结果观察组手术时间、术中出血量、术后肛门排气时间、住院时间均短于对照组(均P<0.05);护理后,观察组SAS评分、SDS评分、VAS评分以及并发症发生率均低于对照组(均P<0.05);护理后观察组认知功能、躯体功能、社会功能、情绪功能等生活质量各项分值均高于对照组(均P<0.05)。结论老年肾结石微创经皮输尿管镜钬激光碎石术治疗开展围手术期护理干预效果显著,可以有效的降低手术创伤,为患者营造良好的康复环境,改善疼痛刺激,并减少患者术后并发症风险。

个性化护理模式在经皮肾镜钬激光碎石联合前列腺电切术治疗良性前列腺增生伴发膀胱结石中的应用

目的探究个性化护理模式对经皮肾镜钬激光碎石联合前列腺电切术(percutaneous neplrolithotripsy,PVP-HoLEP)治疗良性前列腺增生(hyperplasia of prostate,BPH)伴发膀胱结石患者排尿的改善效果。方法选取2020年12月至2022年12月广东省茂名农垦医院收治的100例BPH合并膀胱结石患者作为研究对象,按照随机数字表法分为对照组与观察组,每组50例。对照组采用常规护理,观察组采用个性化护理模式。比较两组排尿情况、护理前后生命质量量表(short form 36 questionnaire,SF-36)、汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)、汉密尔顿抑郁量表(Hamilton depression scale,HAMD)评分及术后并发症发生情况。结果护理前,两组日间、夜间排尿次数、尿失禁频次比较,差异无统计学意义(P>0.05);护理后,观察组日间、夜间排尿次数、尿失禁频次均低于对照组,差异有统计学意义(P<0.05)。护理前,两组SF-36评分比较,差异无统计学意义(P>0.05);护理后,观察组身体机能、心智能力、社会活动、物质差别评分均高于对照组,差异有统计学意义(P<0.05)。护理前,两组HAMA、HAMD评分比较,差异无统计学意义(P>0.05);护理后,观察组HAMA、HAMD评分均低于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论个体化护理模式应用于PVP-HoLEP治疗BPH伴发膀胱结石患者,可改善患者排尿功能,提高其生命质量,降低负性情绪与并发症发生率。

微创经皮肾镜钬激光碎石治疗的肾结石患者手术配合要点及护理体会

目的探讨微创经皮肾镜钬激光碎石治疗的肾结石患者手术配合要点,总结护理体会。方法选取2021年1月—2022年12月在本院进行微创经皮肾镜钬激光碎石术患者70例为研究对象,并将患者分为对照组和观察组,每组35例。其中,对照组采取常规的护理模式,观察组实施优质护理模式,对比两组患者护理效果。结果观察组的护理满意度高于对照组,观察组的配合度优于对照组,观察组的临床手术指标和首次取石成功率优于对照组,差异有统计学意义(P<0.05)。结论与传统的介入方法相比,采用高质量的手术配合护理方法,可以明显地优化肾结石病人的手术指标;提高病人的配合程度,达到良好的疗效,提高病人的满意程度,有利于病人的术后恢复。

Present indications and techniques of percutaneous nephrolithotomy:What the future holds?

The purpose of the review was to present the latest updates on percutaneous nephrolithotomy(PCNL)procedure in terms of indications and evolving techniques,and to identify the advantages and disadvantages of each modality.The data for this review were collected after a thorough PubMed search in core clinical journals in English language.The key words included“PCNL”and“PNL”in combination with“indications”,“techniques”,“review”and“miniaturized PCNL”.Publications relevant to the subject were retrieved and critically reviewed.Current European and American Urology Association Nephrolithiasis Guidelines were included as well.The indications for standard PCNL have been changed through the past decade.Despite evolution of the procedure,innovations and the development of new technical approaches,the indications for miniaturized PCNL have not been standardized yet.There is a need for well-constructed randomized trials to explore the indications,complications and results for each evolving approach.A continuous reduction of tract size is not the only revolution of the last years.There is constant ongoing interest in developing new efficient miniature instruments,intracorporeal lithotripters and sophisticated tract creation methods.We can summarize that,PCNL represents a valuable well-known tool in the field of endourology.We should be open minded to future changes in surgical approaches and technological improvements.

Retrograde intrarenal surgery in pediatric patients

Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-heavy diet and a more sedentary lifestyle are implicated in this increase.Although stone disease is rare in childhood,its presence is frequently associated with metabolic or anatomical disorders or infectious conditions,for which reason there is a high possibility of post-therapeutic recurrence.Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children,with their expectations of a long life.In children in whom active stone removal is decided on,the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality.Thanks to today's advanced technology,renal stones that were once treated only by surgery can now be treated with minimally in-vasive techniques,from invasion of the urinary system in an antegrade(percutaneous nephrolithotomy) or retrograde(retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery.This compilation study examined studies involving the RIRS procedure,the latest minimally invasive technique,in children and compared the results of those studies with those from other techniques.

精细化护理在经皮肾镜超声碎石术治疗肾结石患者中的应用效果分析

目的探讨精细化护理干预在经皮肾镜超声碎石术治疗肾结石患者中的临床应用效果。方法方便选取2018年3月—2021年3月期间在江苏省邳州市人民医院泌尿外科治疗的88例肾结石患者作为研究对象,随机分为对照组和观察组,各44例。对照组患者施以常规护理;观察组患者施予精细化护理。分析比较两组的护理效果。结果两组患者护理前生活质量比较,差异无统计学意义(P>0.05),护理后,观察组患者生活质量评分高于对照组,差异有统计学意义(P<0.05);护理前,两组患者SAS、SDS评分组间比较,差异无统计学意义(P>0.05);护理后,观察组患者SAS、SDS评分和并发症发生率(2.27%)均显著低于对照组,差异有统计学意义(t=10.795、6.914;χ^(2)=13.581,P<0.05)。观察组手术相关指标均优于对照组,差异有统计学意义(P<0.05)。观察组护理质量优于对照组,差异有统计学意义(P<0.05)。结论在经皮肾镜超声碎石术治疗肾结石患者中应用精细化护理干预,能使患者生活质量提升,并发症发生率降低,不良情绪减轻,改善临床表现。

输尿管软镜钬激光碎石术治疗肾下盏结石分析

目的 评价输尿管软镜钬激光碎石术治疗效果,为结石疾病治疗工作提供参考。方法 随机选取2019年5月—2020年8月赤峰市医院泌尿外科收治的肾下盏结石患者80例为研究对象,按照随机数字表法分为两组,各40例。对照组采取经皮肾镜手术治疗,观察组采取输尿管软镜钬激光碎石术治疗。比较两组结石取净率、术后并发症发生率、手术时间、术中出血量、术后住院时间及对治疗满意度情况。结果 观察组患者结石取净率(97.50%)与对照组(90.00%)比较,差异无统计学意义(χ^(2)=0.853,P>0.05)。观察组术后并发症总发生率(5.00%)低于对照组(20.00%),差异有统计学意义(χ^(2)=4.114,P=0.042)。观察组患者手术时间、术后住院时间均短于对照组术后出血量少于对照组,差异有统计学意义(P<0.05)。观察组患者总满意度(97.50%)高于对照组(80.00%),差异有统计学意义(P<0.05)。结论 肾下盏结石采取经皮肾镜、输尿管软镜钬激光碎石术治疗均具有清石效果,但输尿管软镜钬激光碎石术具有安全性、有效性价值,减轻了手术损伤、促进术后恢复,是优选术式,可以满足患者的治疗需求。

3cm以内肾结石微创治疗方案的选择方式探索

比较不同微创手术治疗3cm以内肾结石患者的临床效果,评估得出较好的治疗方式。纳入90例2018年5月—2020年5月期间在贵州省岑巩县人民医院就诊的肾结石患者进行研究。将患者分为两组采用不同的微创手术方案,其中对照组分配患者45例,实施经皮肾镜取石术。观察组分配患者45例,实施输尿管软镜碎石术。严密观察患者的手术情况与术后住院时间,对患者的术后情况进行随访,评估并统计两组一期结石清除成功率,统计术后出现并发症的病例数。结果:对照组平均手术时间(98.31±1.09)min,平均住院天数(7.72±0.45)d,均明显长于观察组的(85.32±2.35)min与(3.35±0.35)d,(t=33.638、51.422,P<0.05)。不同微创手术治疗后两组均出现一定的术后并发症,其中以术后感染较多,观察组总发生率为4.44%,对照组术后出现并发症的一共有8例,总发生率为17.78%,显著高于观察组,(χ2=4.050,P<0.05)。研究发现,临床针对3cm以内肾结石患者,实施输尿管软镜碎石术治疗的综合效果较为理想。

经皮肾镜Cyberwand双导管超声碎石术治疗肾铸型结石的护理

目的探讨经皮肾镜双导管超声碎石术治疗肾铸型结石的优势及护理。方法回顾性分析2009年7月～2010年6月对36例肾铸型结石患者行经皮肾镜双导管超声碎石术的治疗及护理。结果36例均成功建立经皮肾通道并一期取石,手术时间40～100min,平均68min。术中出血量30～150ml,平均72ml。31例结石一次完全取净,清石率86.1%,残留小结石5例,其中泥沙样结石1例,行ESWL治疗后结石排净。住院时间9～12d,平均10d,无护理并发症。全部病例随访1～9个月,无迟发性出血、严重感染等并发症。结论B超引导下经皮肾镜Cyberwand双导管超声碎石清石系统治疗肾铸型结石,具有结石清除率高、手术时间短、出血少、并发症少等优点,手术前后的护理是手术成功及患者顺利康复的重要保障。

输尿管软镜治疗肾结石的临床效果及对肾功能的影响

目的探讨输尿管软镜治疗肾结石近期临床效果及对肾功能的影响,为临床选择合理术式提供理论依据。方法选择符合标准的肾结石患者90例,随机分为观察组和对照组各45例,观察组经输尿管软镜碎石,对照组采用经皮肾镜碎石术,比较两组结石清除率、中性粒细胞明胶酶相关载脂蛋白(NGAL)、血清肌酐(Scr)、半胱氨酸蛋白酶抑制剂C(Cys C)变化。结果两组患者结石清除率差异无统计学意义(P>0.05),但观察组术中出血量及术后住院时间均优于对照组(P<0.05)。两组患者术后12h血清NGAL水平达峰值,观察组术后72h降至术前水平(P>0.05),而对照组仍高于术前水平(P<0.05)。两组患者术后24h血清Cys-C水平达峰值,对照组术后72h降至术前水平(P>0.05),而观察组仍高于术前水平(P<0.05)。结论输尿管软镜碎石术清除肾结石的疗效确切,虽可导致一过性肾功能损伤,但较经皮肾镜碎石术创伤轻、恢复快,值得临床推广。

逆行输尿管软镜碎石术、经皮肾镜与体外冲击波碎石对肾下盏结石有效性和安全性的Meta分析

目的评价逆行输尿管软镜碎石术(RIRS)、经皮肾镜碎石取石术(PCNL)和体外冲击波碎石术(ESWL)治疗肾下盏结石的有效性及安全性。方法通过计算机检索PubMed、Embase、Cochrane图书馆、Web of Science、中国知网、维普及万方等数据库,收集2020年12月前上述3种方式治疗肾下盏结石的随机对照试验或回顾性病例对照试验,严格按照纳入与排除标准对文献进行筛选、数据提取和质量评价,采用Revman 5.3软件进行Meta分析。结果共纳入16项研究,共计2784例肾下盏结石患者。Meta分析结果显示,ESWL术后结石清除率明显低于RIRS和PCNL(OR=0.46,95%CI:0.34~0.63,P<0.05;OR=0.33,95%CI:0.26~0.43,P<0.05)。ESWL术后并发症发生率明显低于PCNL(OR=0.21,95%CI:0.15~0.29,P<0.05);但ESWL与RIRS术后并发症发生率比较差异无统计学意义(OR=0.74,95%CI:0.50~1.09,P>0.05)。ESWL术后再次治疗率明显高于RIRS和PCNL(OR=14.03,95%CI:8.79~22.39,P<0.05;OR=20.62,95%CI:12.87~33.05,P<0.05)。结论与PCNL、RIRS相比,ESWL在治疗肾下盏结石中有效性较低,表现为结石清除率低、再次治疗率高,术后并发症发生率比PCNL高。

腔内泌尿外科技术治疗结石性脓肾的术后护理

应用腔内泌尿外科技术治疗结石性脓肾是一种较为有效的方法。2009年1月～2009年12月,我院收治86例结石性脓肾患者,行经尿道输尿管镜取石或经皮肾镜取石术治疗,总结术后护理经验,强调加强留置管道的护理以及并发症的护理,对减少术后并发症、促进患者康复有重要作用。