可视微通道经皮肾镜一期取石术联合逆行输尿管软镜钬激光碎石术治疗复杂性肾结石的临床研究

目的观察可视微通道经皮肾镜一期取石术联合逆行输尿管软镜钬激光碎石术治疗复杂性肾结石的临床效果。方法选取80例复杂性肾结石患者为研究对象,随机分为对照组40例和观察组40例。对照组接受可视微通道经皮肾镜一期取石术,观察组则给予可视微通道经皮肾镜一期取石术联合逆行输尿管软镜钬激光碎石术。比较两组手术情况,检测手术前后肾损伤因子水平,统计结石清除率和围手术期并发症发生率。结果观察组的术中出血量和住院时间均明显少于对照组(P<0.05),并发症发生率明显低于对照组(P<0.05),而一期手术结石清除率明显高于对照组(P<0.05)。两组术后的NGAL、Cys-C、KIM-1和Scr水平均较术前明显升高(P<0.05),但观察组术后各项肾损伤因子水平均明显低于对照组(P<0.05)。结论可视微通道经皮肾镜一期取石术联合逆行输尿管软镜钬激光碎石术治疗复杂性肾结石患者可有效提高一期手术结石清除率,并减少手术操作对肾脏的损伤,减少术中出血量和围手术期并发症发生,缩短住院时间,促进患者恢复。

The clinical research of visual microchannel percutaneous nephroscopy in primary lithotomy united with antidromic flexible ureteroscope holmium laser lithotripsy in complex renal calculi

Objective To observe the clinical effect of visual microchannel percutaneous nephroscopy in primary lithotomy united with antidromic flexible ureteroscope holmium laser lithotripsy in complex renal calculi.Methods From January 2015 to December 2018,80 cases of patients with complex renal calculi were chosen as studying object.They were divided into control group(40 cases)and observation group(40 cases)according to random number table.The control group received visual microchannel percutaneous nephroscopy in primary lithotomy,while the observation group received antidromic visual microchannel percutaneous nephroscopy in primary lithotomy united with flexible ureteroscope holmium laser lithotripsy.The operation situation of two groups were compared,and renal injury factor before and after operation were detected.And the stone clearance rate and perioperative complication were calculated.Results The intraoperative blood loss and hospital stays of observation group were both less than control group(P<0.05),and the complication rate was lower than control group(P<0.05),but the stone clearance rate in the first stage operation was higher than control group(P<0.05).The NGAL,Cys-C,KIM-1 and Scr level of two groups after operation were all higher than before(P<0.05).And those datas in observation group after operation were all lower than control group(P<0.05).Conclusions Visual microchannel percutaneous nephroscopy in primary lithotomy united with antidromic flexible ureteroscope holmium laser lithotripsy used in patients with complex renal calculi can effectively improve the stone removal rate in the first stage operation,and reduce kidney damage during surgery,and reduce intraoperative blood loss and incidence of perioperative complications.It can shorten hospital stay and promote patient recovery.