摘要
目的:研究对≤≤2.0 cm肾结石分别采用输尿管软镜碎石术与无管化微创经皮肾镜取石效果。方法:回顾性分析2017年6月-2019年6月收治的82例肾结石择期手术患者资料,根据患者自愿选择手术方式分为输尿管软镜碎石术(FURL)组(40例)和无管化微创经皮肾镜碎石取石术(TMPCNL)组(42例)。观察两组患者手术时间、术后血红蛋白下降值、术后白细胞升高值及住院时间,统计两组患者术后2 d、术后1个月碎石清除率、术后并发症及持续高热发生情况。观察两组患者术前、术后1 d、术后5d尿液中肾损伤分子-1(KIM-1)、血清中胱抑素C(CysC)含量。统计入院时及出院两周疼痛视觉模拟量表(VAS)、威斯康辛生活质量问卷(WISQOL)评分情况。结果:两组患者术后白细胞升高值差异无统计学意义(P>0.05),FURL组手术时间明显高于TMPCNL组(P<0.05),FURL组术后血红蛋白下降值、住院时间均明显低于TMPCNL组(P<0.05)。FURL组术后2 d结石清除率低于TMPCNL组(P<0.05),但两组术后1个月结石清除率差异无统计学意义(P>0.05);FURL组术后并发症、持续高热发生率均低于TMPCNL组(P<0.05)。两组术前及术后5 d,KIM-1、CysC含量差异无统计学意义(P>0.05);术后1 d,FURL组KIM-1含量低于TMPCNL组(P<0.05),CysC含量高于TMPCNL组(P<0.05)。FURL组术后VAS评分低于TMPCNL组(P<0.05),FURL组术后WISQOL评分高于TMPCNL组(P<0.05)。结论:两种手术方式对≤2.0 cm肾结石治疗效果均较好,其中FURL手术时间长、住院时短,术后对肾小管及肾小球损伤小,且术后并发症、疼痛状况及生活质量均较好,两种术式远期结石清除率相当,但FURL手术近期结石清除率不如TMPCNL。
Objective:To compare the efficacy of flexible ureteroscopy lithotripsic(FURL)and tubeless mini⁃mally invasive percutaneous nephrolithotomy(TMPCNL)for≤2.0 cm kidney stone.Methods:The clinical data of 82 patients with kidney stone in our hospital from June 2017 to June 2019 were retrospectively analyzed,and the pa⁃tients were divided into FURL group(n=40)and TMPCNL(n=40)according to the voluntary selection of surgical methods.The operation time,postoperative hemoglobin decrease,postoperative leukocyte elevation and hospitaliza⁃tion time were observed in the two groups.The stone clearance rate,postoperative complications and persistent high incidence were statistically analyzed in the two groups 2 days and 1 month after operation.The content of kidney inju⁃ry molecule-1(KIM-1)in urine and cystine C in serum(CysC)were measured in the two groups before operation,1 day after operation and 5 days after operation.The scores of pain visual analogue scale(VAS)and Wisconsin Quality of Life Questionnaire(WISQOL)were recorded at the time of admission and 2 weeks after discharge.Results:There was no significant difference in leukocyte elevation between the two groups after operation(P>0.05).The operation time in the FURL group was significantly longer than that in the TMPCNL group(P<0.05).The postop⁃erative hemoglobin decrease and hospitalization time in the FURL group were significantly reduced as compared with those in the TMPCNL group(P<0.05).The stone clearance rate in FURL group 2 days after operation was signifi⁃cantly lower than that in TMPCNL group(P<0.05),but there was no significant difference in stone clearance rate between the two groups 1 month after operation(P>0.05).The incidence of postoperative complications and persis⁃tent high fever rate in the FURL group were significantly lower than those in the TMPCNL group(P<0.05).There was no significant difference in the content of KIM-1 and CysC between the two groups before and 5 days after operation(P>0.05).The content of KIM-1 in the FURL group 1 day after operation was significantly lower than that in the TMPCNL group(P<0.05),and the content of CysC in the FURL group 1 day after operation was sig⁃nificantly higher than that in the TMPCNL group(P<0.05).The VAS score after operation in the FURL group was significantly lower than that in the TMPCNL group(P<0.05),and the WISQOL score after operation in the FURL group was significantly higher than that in the TMPCNL group(P<0.05).Conclusions:The two surgical methods were effective in the treatment of kidney stones of≤2.0 cm,of which the FURL had such characteristics as long operation time,short hospital stay and small injury to renal tubules and glomeruli after operation,moreover,the postoperative complications,pain and the quality of life were better than the TMPCNL.The long-term stone clear⁃ance rate of the two methods was the same,but the short-term stone clearance rate of FURL was not as good as that of TMPCNL.
作者
王涛
王宏茂
李夕林
何华
王丽晖
WANG Tao;WANG Hongmao;LI Xilin;HE Hua;WANG Lihui(Department of Urology,Jianghan Oilfield General Hospital,Qianjiang 433100,China;Depart⁃ment of Surgery,Three Gorges Hospital of Chongqing University)
出处
《微创泌尿外科杂志》
2020年第2期86-91,共6页
Journal of Minimally Invasive Urology
关键词
肾结石
输尿管软镜碎石术
无管化微创经皮肾镜碎石取石术
疗效
kidney stone
flexible ureteroscopy lithotripsic
tubeless minimally invasive percutaneous nephroli⁃thotomy
curative effect
作者简介
通信作者:王丽晖,84623059@qq.com
