无管化微创经皮肾镜取石术治疗嵌顿性输尿管上段结石临床疗效观察

目的探讨无管化微创经皮肾镜取石术(PCNL)治疗嵌顿性输尿管上段结石的临床疗效。方法126例嵌顿性输尿管上段结石患者,其中66例采用无管化微创PCNL治疗(PCNL组),60例采用经尿道输尿管镜碎石术治疗(TURL组)。比较两组结石清除率、并发症、肾功能、肾脏血流动力学及血电解质水平。结果PCNL组结石清除率高于TURL组(P<0.05),两组并发症率比较,差异无统计学意义(P>0.05)。术后两组血尿素、血肌酐、血清β2-微球蛋白水平均升高(P<0.05),两组间血尿素、血肌酐水平比较,差异无统计学意义(P>0.05),但PCNL组血清β2-微球蛋白水平低于TURL组(P<0.05)。术后两组收缩期最大血流速度(Vs)、舒张末期血流速度(Vd)、阻力指数(RI)均降低,血钠水平升高、血钾水平降低(P<0.05),但两组间比较差异均无统计学意义(P>0.05)。结论对于嵌顿性输尿管上段结石,手术碎石取石会造成患者肾脏血流动力学波动,对患者肾功能及血电解质有轻微影响;无管化微创PCNL治疗效果优于TURL,但两种手术并发症率及对肾功能、肾脏血流动力学及血电解质的影响无差别。

Clinical effect observation of tubeless minimally invasive PCNL in the treatment of incarcerated upper ureteral calculi

Objective To investigate the clinical effects of tubeless minimally invasive percutaneous nephrolithotomy(PCNL)in the treatment of incarcerated upper ureteral calculi.Methods One hundred and twenty-six patients with incarcerated upper ureteral calculi were enrolled in this study.Of these patients,66 patients were treated with tubeless minimally invasive PCNL(PCNL group)and 60 patients were treated with transurethral ureteroscopic lithotomy(TURL group).The stone clearance rate,complications,renal function,renal hemodynamics and blood electrolyte levels were compared between the two groups.Results The stone clearance rate in the PCNL group was higher than that in the TURL group(P<0.05).No statistical difference was found in the incidence of complications(P>0.05).After operation,the levels of blood urea,serum creatinine and serumβ2-microglobulin were increased in both groups(P<0.05).There were no significant differences in blood urea and serum creatinine levels between the two groups after operation(P>0.05),but the PCNL group had lower serumβ2-microglobulin level than TURL group(P<0.05).After operation,maximum blood flow velocity during systole(Vs),end-diastolic blood flow velocity(Vd)and resistance index(RI)were reduced,and the blood sodium level was increased while blood potassium level was decreased in both groups.However,there was no significant difference in these indexes between the two groups(P>0.05).Conclusion For incarcerated upper ureteral calculi,surgical stone removal will cause renal hemodynamic fluctuations and has a slight influence on the patient's renal function and blood electrolytes.Tubeless minimally invasive PCNL is superior to TURL,but these two methods are similar in terms of the incidence of complications and the influence on renal function,renal hemodynamics and blood electrolytes.