微通道经皮肾镜取石与输尿管软镜钬激光碎石对2~4 cm肾结石的取石效果观察  

Effects of microchannel percutaneous nephrolithotomy and flexible ureteroscopic lithoripsy on 2-4 cm kidney stones

作　　者：胡小剑[1] 党晓平[2] 张志刚[1] 郑亮[1] 杜永辉[1] 惠鹏宇[1] 贾磊 党建功[1] HU Xiaojian;DANG Xiaoping;ZHANG Zhigang;ZHENG Liang;DU Yonghui;HUI Pengyu;JIA Lei;DANG Jiangong(Department of Urology,The Second Affiliated Hospital of Xi'an Medical College,Xi'an 710038,China;Department of Neonatology,The Second Affiliated Hospital of Xi'an Medical College,Xi'an 710038,China)

机构地区：[1]西安医学院第二附属医院泌尿外科,陕西西安710038 [2]西安医学院第二附属医院新生儿科,陕西西安710038

出　　处：《西部医学》2024年第12期1829-1833,共5页Medical Journal of West China

基　　金：陕西省卫生健康科研基金项目(2022E029)。

摘　　要：目的 分析微通道经皮肾镜取石(MPCNL)与输尿管软镜钬激光碎石(FURL)对2~4 cm肾结石的取石效果。方法 选取2021年6月—2023年3月我院收治的2~4 cm肾结石患者102例,52例接受MPCNL治疗的为MPCNL组,50例接受FURL治疗的为FURL组。对比两组住院时间、手术时间、术中出血量;比较两组结石清除率;对比两组肾功能指标[血肌酐(Scr)、血尿素氮(BUN)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)]水平;比较两组炎性因子水平(WBC、CRP、IL-6、TNF-α);对比两组术后1个月并发症发生情况。结果 FURL组的住院时间较MPCNL组更短(P<0.05),手术时间较MPCNL组更长(P<0.05),术中出血量少于MPCNL组(P<0.05)。术后1个月,两组的结石清除率比较差异无统计学意义(P>0.05)。术后第3天,FURL组NGAL较MPCNL组高(P<0.05),BUN、Scr较MPCNL组低(P<0.05)。术后第3天,FURL组血清WBC、CRP、IL-6低于MPCNL组(P<0.05),两组TNF-α水平比较差异无统计学意义(P>0.05)。术后1个月,FURL组的并发症发生率低于MPCNL组(P<0.05)。结论 相较MPCNL,FURL用于2~4 cm肾结石有同样高的结石清除率,但FURL能缩短住院时长,减少平均住院日,降低术中出血量,减轻炎症反应及肾功能损伤,且减少并发症。Objective To analyze the effects of microchannel percutaneous nephrolithotomy(MPCNL)and flexible ureteroscopic lithoripsy(FURL)on 2-4cm kidney stones.Methods A total of 102 patients with 2-4 cm kidney stones admitted to the hospital were enrolled from June 2021 to March 2023,including 52 cases in MPCNL group(MPCNL)and 50 cases in FURL group(FURL).The hospitalization time,operation time,intraoperative blood loss,stone clearance rate,levels of renal function indexes[serum creatinine(Scr),blood urea nitrogen(BUN),neutrophil gelatinase-associated lipocalin(NGAL)]and inflammatory factors[white blood cell(WBC),C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factorα(TNF-α)],and occurrence of complications at 1 month after surgery in the two groups were compared.Results The hospitalization time in FURL group was shorter than that in MPCNL group,operation time was longer than that in MPCNL group(P<0.05),and intraoperative blood loss was less than that in MPCNL group(P<0.05).At 1 month after surgery,there was no difference in stone clearance rate between the two groups(P>0.05).At 3d after surgery,NGAL in FURL group were higher than those in MPCNL group(P<0.05),while BUN and Scr was lower than that in MPCNL group(P<0.05).At 3d after surgery,levels of serum WBC,CRP and IL-6 in FURL group were lower than those in MPCNL group(P<0.05).There was no significant difference in TNF-αlevel between the two groups(P>0.05).At 1 month after surgery,incidence of complications in FURL group was lower than that in MPCNL group(P<0.05).Conclusion MPCNL and FURL have the same stone clearance rate.However,the latter can shorten hospitalization time,reduce average length of stay and intraoperative blood loss,relieve inflammatory response and renal injury,and reduce complications in patients with 2-4cm kidney stones.

关 键 词：微通道经皮肾镜碎石取石术 输尿管软镜钬激光碎石取石术 肾结石 肾功能 

分 类 号：R692.4[医药卫生—泌尿科学]