微创与标准通道经皮肾镜治疗肾结石合并肾功能不全的对比研究  

Comparison of mini-percutaneous nephrolithotomy and standard percutaneous nephrolithotomy in the treatment of renal calculi with renal insuficiency

作　　者：周川鹏 杨浩 魏微阳 王奇 黄亚强 Zhou Chuanpeng;Yang Hao;Wei Weiyang;Wang Qi;Huang Yaqiang(Affliated Hospital of Guangdong Medical University,Zhanjiang 524000,China;Zhongshan People's Hospital Afiliated 1o Guangdong Medical Universiy,Guangdong 528400,China)

机构地区：[1]广东医科大学附属医院,湛江524000 [2]广东医科大学附属中山市人民医院,528400

出　　处：《中华腔镜泌尿外科杂志(电子版)》2023年第5期470-475,共6页Chinese Journal of Endourology(Electronic Edition)

基　　金：中山市科技计划项目(2019B1062,2019B1063)。

摘　　要：目的为比较微创经皮肾镜碎石取石术(MPCNL)与标准通道经皮肾镜碎石取石术(SPCNL)治疗肾结石合并肾功能不全的临床疗效。方法回顾性分析广东医科大学附属中山市人民医院2018年1月至2022年3月193例肾结石合并肾功能不全行经皮肾镜碎石取石术(PCNL)患者资料,其中MPCNL117例,SPCNL76例,比较两组患者的净石率(SFR)肾功能变化、手术时间、输血率、并发症发生率等。结果两组患者人口学资料差异无统计学意义(P>0.05)。MPCNL组净石率为72.6%,SPCNL组为69.7%,两组差异无统计学意义(P>0.05)。MPCNL组输血率明显低于SPCNL组(7.7%vs19.7%,P=0.013)。两组患者术后1个月复查肾功能均较术前有明显好转(P<0.05),两组肾功能改变量相比差异无统计学意义(P>0.05)。两组Clavien-Dindo分级并发症差异无统计学意义(P>0.05)。根据慢性肾脏病(CKD)分期不同将患者分为CKD3和CKD4两组,两组SFR及术后Clavien-Dindo分级并发症发生率差异均无统计学意义(P>0.05)。结论MPCNL和SPCNL对肾结石合并肾功能不全患者的治疗均有较高的SFR,总体肾功能均有明显改善,此外,MPCNL输血率更低,住院时间更短。对于肾结石合并肾功能不全患者,特别是CKD3及CKD4期患者,MPCNL可能是更好的治疗方法。Objective To compare the clinical efficacy of mini-percutaneous nephrolithotomy(MPCNL)and standard percutaneous nephrolithotomy(SPCNL)in the treatment of renal calculi with renal insufficiency.Methods The data of 193 patients with renal calculi and renal insufficiency who underwent percutaneous nephrolithotomy(PCNL)in Zhongshan People's Hospital Affiliated to Guangdong Medical University from January 2018 to March 2022 were retrospectively analyzed.The stone free rate(SFR),renal function,operation time,blood transfusion rate and complication rate of the two groups,including 117 cases of MPCNL and 76 cases of SPCNL were compared.Results There was no significant difference in demographic data between the two groups(P>0.05).The SFR was 72.6%in MPCNL group and 69.7%in SPCNL group,there was no significant difference in SFR between the two groups(P>0.05).The transfusion rate in MPCNL group was significantly lower than that in SPCNL group(7.7%vs 19.7%,P=0.013).The renal function of the two groups was significantly improved at 1 month after operation(P<0.05),but there was no significant difference in the change of renal function between the two groups(P>0.05).There was no significant difference in complications of Clavien-Dindo classification between the two groups(P>0.05).Patients were divided into two groups,CKD3 and CKD4,according to the different stages of CKD.The differences in SFR and postoperative Clavien-Dindo classification complication rates between the two groups were not statistically significant.Conclusions MPCNL and SPCNL have good effect in the treatment of patients with renal calculi and renal insufficiency,both have high SFR,and the overall renal function is significantly improved.In addition,MPCNL has lower transfusion rate and shorter hospital stay.MPCNL may be a better treatment for patients with renal calculi and renal insufficiency,especially in patients with CKD3 and CKD4.

关 键 词：肾功能不全 肾结石 经皮肾镜 序贯器官衰竭评分 慢性肾脏病 

分 类 号：R699.2[医药卫生—泌尿科学]