微创经皮肾镜碎石取石术与输尿管软镜碎石取石术治疗老年复杂性肾结石患者的效果比较  

Comparison of effects of minimally invasive percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy in treatment of elderly patients with complex renal calculi

作　　者：彭光辉 王玉勤 刘成珠 PENG Guanghui;WANG Yuqin;LIU Chengzhu(Department of Urology of Yingtan People’s Hospital,Yingtan 335000 Jiangxi,China)

机构地区：[1]鹰潭市人民医院泌尿外科,江西鹰潭335000

出　　处：《中国民康医学》2025年第4期144-147,共4页Medical Journal of Chinese People’s Health

基　　金：鹰潭市指导性科技计划项目(2023-9-23246)。

摘　　要：目的:比较微创经皮肾镜碎石取石术与输尿管软镜碎石取石术治疗老年复杂性肾结石患者的效果。方法:回顾性分析2023年2月至2024年4月该院收治的60例老年复杂性肾结石患者的临床资料,依据手术方案不同将其分成对照组和研究组各30例。对照组采用输尿管软镜碎石取石术治疗,研究组采用微创经皮肾镜碎石取石术治疗。比较两组手术相关指标(手术时间、术中出血量、结石清除率)水平,手术前后应激反应指标[促肾上腺皮质激素(ACTH)、皮质醇(Cor)、去甲肾上腺素(NE)]水平、肾损伤因子[胱抑素C(Cys-C)、血肌酐(Scr)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)]水平和并发症发生率。结果:研究组手术时间长于对照组,术中出血量多于对照组,结石清除率高于对照组,差异均有统计学意义(P<0.05);术后3 d,两组ACTH、Cor、NE水平均高于术前,但研究组低于对照组,差异有统计学意义(P<0.05);两组Cys-C、Scr、NGAL水平均高于术前,但研究组低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为6.67%,低于对照组的26.67%,差异有统计学意义(P<0.05)。结论:微创经皮肾镜碎石取石术治疗老年复杂性肾结石可提高结石清除率,以及降低应激反应指标水平、肾损伤因子水平和并发症发生率的效果优于输尿管软镜碎石取石术治疗,但可延长手术时间和增加术中出血量。Objective:To compare effects of minimally invasive percutaneous nephrolithotomy and flexible ureteroscopic lithotripsy in treatment of elderly patients with complex renal calculi.Methods:The clinical data of 60 elderly patients with complex renal calculi admitted to this hospital from February 2023 to April 2024 were retrospectively analyzed.According to different surgical schemes,they were divided into control group and study group,30 cases in each group.The control group was treated with flexible ureteroscopic lithotripsy,while the study group was treated with minimally invasive percutaneous nephrolithotomy.The levels of operation-related indicators(operation time,intraoperative blood loss,stone clearance rate),stress response indicators[adrenocorticotropic hormone(ACTH),cortisol(Cor),norepinephrine(NE)],and renal injury factors[cystatin C(Cys-C),serum creatinine(Scr),neutrophil gelatinase-associated lipocalin(NGAL)]before and after the surgery,and the incidence of complications were compared between the two groups.Results:The operation time of the study group was longer than that of the control group,the intraoperative blood loss was more than that of the control group,the stone clearance rate was higher than that of the control group,and the differences were statistically significant(P<0.05).At 3 days after the surgery,the levels of ACTH,Cor and NE in the two groups were higher than those before the surgery,but those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).At 3 days after surgery,the levels of Cys-C,Scr and NGAL in the two groups were higher than those before the surgery,but those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the study group was 6.67%,which was lower than 26.67%in the control group,and the difference was statistically significant(P<0.05).Conclusions:Minimally invasive percutaneous nephrolithotomy i

关 键 词：微创经皮肾镜碎石取石术 输尿管软镜碎石取石术 老年 复杂性肾结石 应激反应 肾损伤 并发症 

分 类 号：R692[医药卫生—泌尿科学]