经皮肾镜联合输尿管软镜治疗老年复杂性肾结石的临床观察

目的评价经皮肾镜联合输尿管软镜治疗复杂性肾结石的临床疗效。方法选择我院于2015年1月至2016年12月期间收治的88例老年复杂性肾结石患者作为研究对象,按照入院单双号顺序分为对照组和观察组,每组44例,其中对照组予以经皮肾镜碎石术(PCNL)治疗,观察组采用经皮肾镜联合输尿管软镜治疗。比较两组术前、术后3 d和术后1个月时的血清尿素氮(SUN)和肌酐(Sc R)、血清胱抑素C(Cys C)、β2-微球蛋白(β2-MG)、尿酸(UA)水平,分别于术前、术后6 h、术后24 h采集患者静脉血测定血清去甲肾上腺素(NE)、皮质醇(Cor)、多巴胺(DA)水平。比较两组结石清除率、术后出血和感染等并发症情况。结果观察组术后3d、30 d结石清除率分别为93.94%、97.73%,均明显高于对照组(P0.05),观察组术后3 d和30 d血清SUN、Sc R、UA、β2-MG和Cys C水平均明显低于对照组(P0.05)。观察组术后6 h和术后24 h时NE、Cor和DA均显著低于对照组(P0.05)。观察组住院天数及术后并发症总发生率分别为(4.13±1.28)d、6.82%,均明显低于对照组(P0.05)。结论与经皮肾镜碎石术相比,经皮肾镜联合输尿管软镜治疗老年复杂性肾结石的净石率更高、术后肾功能恢复更快,且并发症较少。

Effects of percutaneous nephrolithotomy combined with ureteroscopy on the treatment of complex renal calculi in the elderly

［Abstract］ Objective To evaluate the clinical efficacy of percutaneous nephrolithotomy （PCNL） combined with flexible ureteroscope on complex renal calculi in the elderly. Methods Eighty?eight elderly patients with complex renal calculi in our hospital from January 2015 to December 2016, were divided into control group and observation group in accordance with the admission number and even order, 44 cases in each group. The control group was given PCNL treatment, and the observation group were treated with PCNL combined with flexible ureteroscopic. The levels of serum urea nitrogen（SUN）, serum creatinine（ScR）, cystain C（CysC）, β2?MG, uric acid（UA）of the two groups were tested and compared. Serum norepinephrine（NE）, cortisol（Cor）and dopamine（DA）levels were measured preoperatively, postoperatively 6 h and postoperatively 24 h. The stone clearance rate, postoperative bleeding and infection complications were compared between the two groups. Results The stone clearance rates at postoperative 3 d and 30 d of the observation group were 93.94% , 97.73% , and both were significantly higher than those of the control group （P<0.05）. The levels of SUN, ScR, UA, β2?MG and CysC at postoperative 3 d and 30 d of the observation group were significantly lower than those of the control group （P<0.05）. The levels of NE, Cor, DA of the observation group at postoperative 6h and postoperative 24h were lower than those of the control group（P<0.05）. The length of stay and total complication rate of the observation group were 4.13 ± 1.28 d, 6.82% , and were also significantly lower than those of the control group （P<0.05）. Conclusion Compared with PCNL, percutaneous nephrolithotomy combined with flexible ureteroscopy has higher rate of stone removal, faster recovery of renal function and less complications in the treatment of complex renal calculi.