标准通道经皮肾镜取石术联合输尿管软镜钬激光碎石术治疗上尿路结石的疗效观察  

Effects of standard-channel PCNL combined with transurethral flexible ureteroscope holmium laser lithotripsy in patients with upper urinary tract calculi

作　　者：刘津念 郑剑[1] 殷永健 盛夏[1] 陈天[1] LIU Jin-nian;ZHENG Jian;YIN Yong-jian;SHENG Xia;CHEN Tian(Department of Urology, Banan District Second People's Hospital, Chongqing 400054, China)

机构地区：[1]重庆市巴南区第二人民医院泌尿外科,重庆400054

出　　处：《实用医院临床杂志》2019年第1期164-167,共4页Practical Journal of Clinical Medicine

摘　　要：目的探讨标准通道经皮肾镜取石术(SPCNL)联合输尿管软镜钬激光碎石术(FURL)对上尿路结石患者结石清除率、肾功能指标及血液动力学的影响。方法上尿路结石患者108例,采用随机数字表法分为观察组和对照组各54例,对照组采用SPCNL术,观察组采用SPCNL术联合FURL术,记录两组手术一般情况、结石清除率、手术前后肾功能、血液动力学及并发症发生情况。结果观察组手术时间、结石清除率高于对照组,术后血红蛋白下降值、肾造瘘管留置时间、术后住院时间低于对照组(P <0. 05),两组住院费用比较差异无统计学意义(P> 0. 05);术后两组血清尿素(UA)、肌酐(Cr)、β2-微球蛋白(β2-MG)水平均上升(P <0. 05),组间比较差异无统计学意义(P> 0. 05);灌流后30 min两组平均动脉压(MAP)、中心静脉压(CVP)均上升(P <0. 05),组间各时点比较差异无统计学意义(P> 0. 05);两组术后并发症发生率比较,差异无统计学意义(P> 0. 05)。结论与SPCNL术相比,SPCNL联合FURL术治疗上尿路结石虽然会延长手术时间,但结石清除率更高,术后恢复快,且不会增加肾功能损伤,对血液动力学影响较小,值得临床推广应用。Objective To investigate the effects of standard-channel percutaneous nephrolithotomy( SPCNL) combined with transurethral flexible ureteroscope holmium laser lithotripsy( FURL) on stone clearance rate,renal function indexes and hemodynamics in patients with upper urinary tract calculi.Methods One hundred and eight patients with upper urinary tract calculi were randomly divided into observation or control group,54 in each group.The control group was treated with SPCNL,and the observation group was given SPCNL combined with FURL.The general condition,stone clearance rate,renal function indexes such as urea( UA),creatinine( Cr)and β2-microglobulin( β2-MG) before and after operation,hemodynamic indexes such as mean arterial pressure( MAP),heart rate( HR),central venous pressure( CVP) and occurrence of complications were recorded in the two groups.Results The operative time and stone clearance rate in the observation group were longer and higher than those in the control group,but the hemoglobin decrease,indwelling time of renal fistula and postoperative hospital stay in the observation group were less and shorter than those in the control group( P < 0. 05).The difference in hospitalization expense was not statistically significant( P > 0. 05).The serum levels of UA,Cr andβ2-MG were increased after operation in the two groups( P < 0. 05),but there was no significant difference between the two groups( P> 0. 05).The MAP and CVP were increased in the two groups after 30 min of perfusion( P < 0. 05),but there was no significant difference in MAP,CVP and HR between the two groups at each time points( P > 0. 05).The incidence rate of postoperative complications in the observation group was slightly higher than that in the control group( 16. 67% vs.12. 96%) but not statistically significant( P >0. 05).Conclusion Compared with SPCNL alone,SPCNL combined with FURL for upper urinary tract calculi will prolong the operative time,but it has higher stone clearance rate and quicker postoperative recovery.It does not increase ren

关 键 词：标准通道 PCNL 输尿管软镜钬激光碎石 上尿路结石 结石清除率 肾功能 血液动力学 

分 类 号：R693.4[医药卫生—泌尿科学]