经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石疗效观察  

Therapeutic effect of percutaneous nephrolithotomy combined with ureteroscopy-guided holmium laser lithotripsy in the treatment of complicated renal calculi

作　　者：袁文兵[1] 李正义 刘双宁 刘玮[1] YUAN Wen-bing;LI Zheng-yi;LIU Shuang-ning;LIU Wei(Department of Urology,Baoji People's Hospital,Baoji 721000,Shaanxi,CHINA)

机构地区：[1]宝鸡市人民医院泌尿外科

出　　处：《海南医学》2019年第22期2915-2918,共4页Hainan Medical Journal

摘　　要：目的观察经皮肾镜联合输尿管软镜狄激光碎石术治疗复杂性肾结石的临床疗效。方法选择2016年5月至2018年7月宝鸡市人民医院泌尿外科收治的220例复杂性肾结石患者,按随机数表法分为观察组和对照组,每组110例,对照组患者采用经皮肾镜碎石术治疗,观察组患者在对照组治疗的基础上联合输尿管软镜狄激光碎石术治疗。比较两组患者的围术情况、肾功能、结石清除情况及并发症,全部患者均在术后1个月复查。结果观察组患者的手术时间和术中出血量分别为(128.51±14.62)min、(145.33±17.04)mL,均明显高于对照组的(113.74±15.13)min、(136.28±19.52)mL,住院时间为(6.45±1.47)d,明显少于对照组的(10.29±1.33)d,差异均具有统计学意义(P<0.05);观察组患者的血清肌酐(Scr)、尿素氮(BUN)水平、尿β2-微球蛋白(β2-MG)分别为(83.60±13.58)μmol/L、(6.44±2.13)mmol/L、(3.18±0.49)mg/L,均明显低于对照组的(95.09±13.41)μmol/L、(8.29±2.20)mmol/L、(4.52±0.57)mg/L,差异均有统计学意义(P<0.05);观察组患者的结石清除率为96.36%,明显高于对照组的85.45%,术后并发症总发生率为1.82%,明显低于对照组的10.91%,差异均有统计学意义(P<0.05)。结论经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石具有创伤小、住院时间短、并发症少、安全可靠的特点,值得临床中推广应用。Objective To assess the clinical effect of percutaneous nephrolithotripsy(PCNL)combined with ureteroscopy-guided holmium laser lithotripsy in the treatment of complex renal calculi.Methods A total of 220 patients with complex renal calculi,who admitted to Department of Urology,Baoji People's Hospital from May 2016 to July 2018,were selected and divided into the observation group and control group according to random number table method,with 110 cases in each group.The control group was treated with PCNL,and the observation group was treated with flexible ureteroscopy and holmium laser lithotripsy on the basis of the control group.The perioperative situation,renal function,stone clearance and complications of the two groups were compared.All patients were reexamined one month after operation.Results The operation time and intraoperative bleeding volume in the observation group were(128.51±14.62)min,(145.33±17.04)mL,respectively,which were significantly higher than corresponding(113.74±15.13)min and(136.28±19.52)mL in the control group,and hospitalization time was(6.45±1.47)d versus(10.29±1.33)d(all P<0.05);the levels of serum creatinine(Scr),urea nitrogen(BUN),and urinaryβ2-microglobulin(β2-MG)in the observation group were(83.60±13.58)μmol/L,(6.44±2.13)mmol/L,(3.18±0.49)mg/L,respectively,which were significantly lower than corresponding(95.09±13.41)μmol/L,(8.29±2.20)mmol/L,(4.52±0.57)mg/L in the control group(all P<0.05);the stone clearance rate of the observation group was 96.36%,which was significantly higher than 85.45%of the control group(P<0.05);the total incidence of postoperative complications in the observation group was 1.82%versus 10.91%in the control group(P<0.05).Conclusion In the treatment of complex renal calculi,the combined use of percutaneous nephrolithotomy and holmium laser lithotripsy under flexible ureteroscope has the characteristics of less trauma,shorter hospitalization time,fewer complications,good safety and reliability,which is worth popularizing and applying in clinic.

关 键 词：经皮肾镜 输尿管软镜 钬激光碎石术 复杂性肾结石 疗效 

分 类 号：R692.4[医药卫生—泌尿科学]