PCNL、RIRS治疗孤立肾结石围术期相关指标及近期疗效比较  

Observation of Perioperative Related Indicators and Short-term Curative Effect of PCNL and RIRS in the Treatment of Isolated Kidney Stone

作　　者：尹宁[1] 韩平[2] 李永洪[1] 陈玉雄 Yi Ning;HAN Ping;LI Yong-hong(Nephrology department,Shizhong county people＇s hospital.Zizhong 641200,Sichuan Province,China)

机构地区：[1]四川省资中县人民医院肾内科,四川资中641200 [2]四川大学华西医院泌尿外科,四川成都610041

出　　处：《医学临床研究》2018年第8期1527-1529,1532,共4页Journal of Clinical Research

摘　　要：[目的]比较经皮肾镜碎石取石术（PCNL）、输尿管软镜碎石术（RIRS）治疗孤立肾结石围术期相关指标及近期疗效.[方法]96例孤立肾结石患者,随机分为A组（PCNL组）与B组（RIRS组）,各48例.比较两组手术情况、术晨与术后d1的血清白细胞介素6（IL-6）、C反应蛋白（CRP）、白细胞计数（WBC）、皮质醇（Cor）水平,术后不同时间点静息状态及活动状态下视觉模拟评分（VAS）疼痛评分、结石一期清除率、总清除率、并发症总发生率.[结果]A组手术时间短于B组（P〈0.05）,术中出血量、胃肠功能恢复时间与住院时间高于B组（P〈0.05）.B组术后d1的血清IL-6、CRP、WBC、Cor水平均低于A组（P〈0.05）.B组术后d1、d2、d3静息状态及活动状态下的疼痛VAS评分均低于A组（P〈0.05）.A组结石一次性清除率为81.25％（39/48）,总清除率为93.75％（45/48）,并发症总发生率为18.75％（9/48）;B组分别为72.92％（35/48）、85.42％（41/48）,20.83％（10/48）,两组比较差异均无显著性（P〉0.05）.[结论]RIRS可取得与PCNL相当的总体碎石效果,且术中出血减少、住院时间短,疼痛与炎症反应轻,在把握好手术适应证的前提下可作为孤立肾结石的首选治疗方案.[Objective]To compare the perioperative related indicators and short-term efficacy of percutaneous nephrolithotomy （PCNL） and ureteroscopy （RIRS） in the treatment of isolated kidney stones. [Methods]A total of 96 patients with isolated kidney stones were random divided into group A（PCNL） and group B（RIRS）,with 48 cases in each group. Levels of serum interleukin 6 （IL-6）, C-reactive protein （CRP）, white blood cell count （WBC）, and cortisol （Cor） in the morning before surgery and on the lth day after surgery were detected. The pro- cedure of operation was monitored. The VAS pain scores of resting state and active state at different time points after surgery, primary stone clearance rate, total clearance rate, and total incidence of complications were com- pared between two groups. [Results]The operation time of group A was shorter than that of B group （ P〈0.05）, while the intraoper-ative blood loss, gastrointestinal function recovery time and hospitalization time were higher than those in B group （ P〈0.05）. The levels of serum IL-6, CRP, WBC and Cor in group B were lower than those in group A （ P 〈0.05）. The VAS scores of resting state and active state in the group B at ld, 2d and3d after surgery were lower than those in the A group （ P 〈0.05）. The one-time primary stone clearance rate , total clearance rate and the total incidence of complications in group A were 81.25%, 93.75% and 18.75%, respectively, which were not significantly different in comparison with those in group B, which were 72.92%.85.42% and 20.83%, respectively （ P〉0.05）. [Conclusion] RIRS can achieve the equivalent overall effect of PCNL; however, RIRS has less intraoperative bleeding , shorter hospital stay, and reduced pain and inflammation. It can be used as a preferred treatment under the premise of grasping the surgical indications.

关 键 词：肾结石/外科学 肾造口术 经皮 输尿管镜检查 白细胞介素6/血液 C反应蛋白质/ 血液 

分 类 号：R692.4[医药卫生—泌尿科学]