经皮肾镜联合输尿管软镜取石术治疗输尿管结石合并同侧肾结石的效果研究  

Study on the Effect of Percutaneous Nephroscopy Combined with Flexible Ureteroscopy in the Treatment of Ureteral Calculi with Ipsilateral Renal Calculi

作　　者：岳济 雷超[1] 刘袁林 陈彦君 YUE Ji;LEI Chao;LIU Yuanlin;CHEN Yanjun(Department of Urinary Surgery,the First People's Hospital of Guangyuan City,Guangyuan,Sichuan 628017,China)

机构地区：[1]广元市第一人民医院泌尿外科,四川广元628017

出　　处：《转化医学杂志》2024年第1期95-100,共6页Translational Medicine Journal

基　　金：四川省卫生健康委员会项目(20PJ312)。

摘　　要：目的分析经皮肾镜联合输尿管软镜取石术(RIRS)治疗输尿管结石合并同侧肾结石的应用优势。方法选取2020年1月—2023年1月150例输尿管结石合并同侧肾结石患者,随机分为2组各75例,肾镜组行经皮肾镜取石术(PCNL),双镜组采用PCNL联合RIRS。比较2组围术期指标、术后并发症发生率、术后视觉模拟评分法(VAS)评分及尿液代谢异常发生率,术前及术后神经源炎症反应指标[神经生长因子(NGF)、前列腺素E_(2)(PGE_(2))、C反应蛋白(CRP)、P物质(SP)]、肾功能指标[血清肌酐(Cr)、尿素(UREA)、肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关载脂蛋白(NGAL)]。结果双镜组手术时间、住院天数短于肾镜组,术中出血量低于肾镜组,术后3 d、术后1个月结石清除率高于肾镜组(P<0.01)。双镜组术后并发症发生率为2.67%(2/75)低于肾镜组的12.00%(9/75)(P<0.05)。双镜组术后6、12、24、48 h VAS评分低于肾镜组(P<0.05)。双镜组术后24、48 h NGF、PGE_(2)、CRP及SP均低于肾镜组(P<0.05)。术后1周、2周双镜组Cr、UREA、KIM-1及NGAL低于肾镜组(P<0.05)。双镜组术后2周高尿酸尿症、高草酸尿症、低枸橼酸尿症、高钙尿症及低镁尿症发生率均较肾镜组低(P<0.05)。结论PCNL联合RIRS治疗输尿管结石合并同侧肾结石患者可优化手术操作,抑制神经源炎症反应,减轻术后疼痛与肾功能损伤,且能提高结石清除率,降低并发症风险,改善尿液代谢状态。Objective To analyze the application advantages of percutaneous nephrolithotomy(PCNL)combined with retrograde intrarenal surgery(RIRS)in the treatment of patients with ureteral calculi complicated with ipilateral renal calculi.Methods From January 2020 to January 2023,150 patients with ureteral calculi combined with ipilateral renal calculi were randomly divided into two groups,with 75 cases in each group.PCNL was performed in the nephroscopy group,and PCNL combined with RIRS was performed in the PCNL+RIRS group.Perioperative indicators,incidence of postoperative complication rate,postoperative visual analogue scale(VAS)score and incidence of abnormal urine metabolism were compared between the two groups.Preoperative and postoperative neurogenic inflammatory response indicators[nerve growth factor(NGF),prostaglandin E_(2)(PGE_(2)),C-reactive protein(CRP),Substance P(SP)],renal function indicators[serum creatinine(Cr),UREA,kidney injury molecule 1(KIM-1),neutrophil gelatinase-associated apolipoprotein(NGAL)]were compared between the two groups.Results The duration of operation and hospitalization days of the PCNL+RIRS group were shorter than those of the nephroscopy group,the amount of intraoperative blood loss was lower than that of the nephroscopy group,and the stone clearance rate at 3 days and 1 month after the operation was higher than that of the nephroscopy group(P<0.01).The incidence of postoperative complications was 2.67%(2/75)in the PCNL+RIRS group,which was lower than that[12.00%(9/75)]in the nephroscopy group(P<0.05).The VAS scores at 6,12,24 and 48 h after operation in the PCNL+RIRS group were lower than those in the nephroscopy group(P<0.05).NGF,PGE_(2),CRP and SP in the PCNL+RIRS groups were lower than those in the nephroscopy group at 24 and 48 h after surgery(P<0.05).Cr,UREA,KIM-1 and NGAL in the PCNL+RIRS group were lower than those in the nephroscopy group at 1 and 2 weeks after surgery(P<0.05).The incidence of hyperuricuria,hyperoxaluria,hypocitrouria,hypercalcemia and hypomagnesia at 2 weeks

关 键 词：输尿管结石 肾结石 输尿管镜取石术 经皮肾镜取石术 结石清除率 神经生长因子 肾损伤分子-1 手术后并发症 

分 类 号：R699[医药卫生—泌尿科学]