超声引导下针状肾镜联合标准通道与多通道PCNL治疗肾结石的效果比较  

Comparison of ultrasound-guided needle nephroscopy combined with standard channel and multi-channel percutaneous nephrolithotomy in the treatment of renal calculus

作　　者：孔莹莹 吴辉[2] 冯战启[2] 陈轶杰[1] 王云玲[1] KONG Yingying;WU Hui;FENG Zhanqi;CHEN Yijie;WANG Yunling(Department of Ultrasonography,Zhengzhou First People's Hospital,Zhengzhou,450000,China;Department of Urology,Zhengzhou First People's Hospital)

机构地区：[1]郑州市第一人民医院超声科,郑州450000 [2]郑州市第一人民医院泌尿外科

出　　处：《临床泌尿外科杂志》2022年第3期163-167,共5页Journal of Clinical Urology

基　　金：河南省医学科技攻关计划项目(No:LHGJ20210717)。

摘　　要：目的:比较超声引导下针状肾镜联合标准通道与多通道经皮肾镜取石术(PCNL)治疗肾结石的效果。方法:回顾性分析2019年5月-2020年8月郑州市第一人民医院收治的98例肾结石患者的临床资料,其中行超声引导下多通道PCNL治疗49例(对照组),行超声引导下针状肾镜术联合标准通道PCNL治疗49例(观察组)。比较两组患者手术各项指标(手术时间、术中出血量、住院时间、住院费用)、术后疼痛程度、结石清除率、炎性因子、术后并发症发生率。结果:观察组手术各项指标和术后炎性因子水平均明显优于对照组,住院费用高于对照组(P<0.05)。术后观察组视觉模拟评分法(VAS)评分低于对照组(P<0.05)。观察组和对照组结石清除率分别为95.92%、91.84%,差异无统计学意义(P>0.05)。观察组术后并发症发生率低于对照组(P<0.05)。多因素logistic回归分析结果显示,手术时间、VAS评分及术后超敏C-反应蛋白、降钙素原、血红蛋白水平与针状肾镜术联合标准通道PCNL治疗肾结石患者的效果相关(P<0.05)。结论:在超声引导下,多通道PCNL和针状肾镜术联合标准通道PCNL均可有效地清除肾结石,但超声引导下针状肾镜术联合标准通道PCNL能更有效地改善手术各项指标,减轻术后疼痛程度,降低术后炎症反应和并发症发生率,是较为理想的手术方法。Objective:To compare the effects of ultrasound guided needle nephroscopy combined with standard channel and multi-channel percutaneous nephrolithotomy in the treatment of renal calculus.Methods:A retrospec-tive analysis was performed on 98 patients with renal calculus admitted to Zhengzhou First People's Hospital from May 2019 to August 2020.The control group(49 cases)received ultrasound guided multi tract percutaneous nephrolithotomy,and the observation group(49 cases)received ultrasound-guided needle nephroscopy combined with standard percutaneous nephrolithotomy.The surgical indicators(operating time,intraoperative blood loss,hospitalization time and hospitalization cost),postoperative pain,stone removal rate.inflammatory factors and postoperative complications were compared between the two groups.Results:The indexes of operation and the level of postoperative inflammatory factors in the observation group were significantly better than those in the con-trol group,but the hospitalization cost was higher than that in the control group(P<0.05).The Visual Analogue Scale(VAS)score of the observation group was lower than that of the control group(P<0.05),The stone re-moval rates of the observation group and the control group were 95.92%and 91.84%,respectively,and the difference was not statistically significant(P>0.05).The postoperative complication rate was lower in the obser-vation group than in the control group(P<0.05).Multivariate Logistic regression analysis showed that the oper-ation time,VAS score,postoperative high-sensitivity C-reactive protein,procalcitonin and hemoglobin levels were correlated with the effect of needle nephroscopy combined with standard channel percutaneous nephrolithotomy in the treatment of renal calculus(P<0.05).Conclusion;Under the guidance of ultrasound,multi-channel percuta-neous nephrolithotomy and needle nephroscopy combined with standard channel percutaneous nephrolithotomy can effectively remove renal calculus,but ultrasound guided needle nephroscopy combined with standard chan

关 键 词：针状肾镜 多通道经皮肾镜取石术 肾结石 结石清除率 

分 类 号：R692.4[医药卫生—泌尿科学]