微通道经皮肾镜取石术与逆行肾内手术治疗老年单侧输尿管上段结石的效果比较  

Comparison of MPCNL and RIRS in the treatment of unilateral upper ureteral calculi in the elderly

作　　者：李国栋 李志江 陈亮 全岳鹏 LI Guodong;LI Zhijiang;CHEN Liang;QUAN Yuepeng(People's Hospital of Longyou County,Zhejiang 324400,China)

机构地区：[1]浙江省龙游县人民医院,龙游324400

出　　处：《浙江创伤外科》2025年第3期420-423,共4页Zhejiang Journal of Traumatic Surgery

摘　　要：目的 比较微通道经皮肾镜取石术(MPCNL)与逆行肾内手术(RIRS)在治疗老年单侧输尿管上段结石方面的效果差异。方法 回顾性选择2022年6月至2024年1月本院收治的62例老年单侧输尿管上段结石患者病历资料,依据不同手术方法分为33例MPCNL组及29例RIRS组。比较两组手术指标(手术时间、术中出血量、住院时间及一期结石清除率),术后24 h肾功能(血肌酐、血尿素氮、胱抑素C)及应激激素(皮质醇、去甲肾上腺素)和并发症情况。结果 MPCNL组手术时间少于RIRS组,MPCNL组术中出血量及一期结石清除率较RIRS组高,差异有统计学意义(P<0.05);两组住院时间差异无统计学意义(P>0.05)。MPCNL组肾功能及应激激素指标水平较RIRS组高,有统计学差异(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论 老年单侧输尿管上段结石采用MPCNL治疗在手术时间及一期结石清除率方面更有优势,而RIRS的出血量更少,对肾功能及应激反应的影响更小,且两种术式的手术并发症发生率相似。临床应根据患者具体情况合理选择手术方式。Objective To compare the effect of micro-channel percutaneous nephrolithotomy(MPCNL) and retrograde intrarenal surgery(RIRS) in the treatment of elderly patients with unilateral upper ureteral calculi.Methods The medical records of 62 elderly patients with unilateral upper ureteral calculi admitted to our hospital from June 2022 to January 2024 were retrospectively selected and divided into MPCNL group(33cases) and RIRS group(29 cases) according to different surgical methods.The surgical indexes(operation time,intraoperative blood loss,hospitaliza-tion time and primary stone clearance rate),renal function(serum creatinine,blood urea nitrogen and cystatin C) and stress hormones(cortisol,nore-pinephrine) at 24 hours after operation and complications were compared between the two groups.Results The operative time of MPCNL group was shorter than that of RIRS group,and the intraoperative blood loss and the primary stone clearance rate of MPCNL group were higher than those of RIRS group,with statistical difference(P<0.05).There was no significant difference in hospital stay between the two groups(P>0.05).The renal function and stress hormone indexes in MPCNL group were higher than those in RIRS group,with statistical difference( P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion In elderly patients with unilateral upper ureteral calculi,MPCNL treatment has more advantages in terms of operation time and first-stage stone clearance rate,while RIRS has less blood loss and less impact on renal function and stress response,and the incidence of surgical complications of the two operations is similar.Therefore,surgical methods should be reasonably selected according to the specific conditions of patients.

关 键 词：老年 输尿管上段结石 微通道经皮肾镜取石术 逆行肾内手术 

分 类 号：R699.2[医药卫生—泌尿科学]