标准通道经皮肾镜取石术联合输尿管软镜钬激光碎石术对上尿路结石患者的结石清除率、肾功能指标及血流动力学的影响

目的 研究标准通道经皮肾镜取石术(SPCNL)联合输尿管软镜钬激光碎石术(FURS)对上尿路结石患者结石清除率、肾功能指标及血流动力学的影响。方法 选取2017年3月至2019年6月入院的84例上尿路结石患者，参考随机数字表法分为两组，各42例，对照组SPCNL治疗，研究组联用SPCNL与FURS治疗。比较两组手术前后肾功能指标β2 微球蛋白、血肌酐、血尿素氮（BUN）]、血流动力学指标（中心静脉压、平均动脉压及心率）水平与术后结石清除率、手术时间、肾造瘘管留置时间、住院时间及并发症发生率。结果 两组术前肾功能指标、血流动力学指标水平比较，差异无统计学意义（P＞0.05）；对比术前，两组术后肾功能指标水平更高（P＜0.05），而两组术后血流动力学指标比较，差异无统计学意义（P＞0.05）；两组术后肾功能指标、血流动力学指标水平与并发症发生率比较，差异无统计学意义（P＞0.05）；对比对照组，研究组术后结石清除率更高，手术时间更长，肾造瘘管留置时间、住院时间更短（P＜0.05）。结论 SPCNL联合FURS治疗上尿路结石的效果显著，虽然手术时间长于单用SPCNL，但术后结石清除率更高，且对患者血流动力学指标的影响较小，可有效改善肾功能。 〖HT5”H〗〓〓【关键词】〓〖HT5”SS〗尿路结石；肾造口术, 经皮；输尿管镜检查；碎石术, 激光 〖HT5”H〗〓〓DOI：〖HT5”SS〗10.3760/cma.j.cn431460 20190203 00001

Effect of standard channel percutaneous nephrolithotomy combined with flexible ureteroscopic holmium laser lithotripsy on stone clearance,renal function and hemodynamics in patients with upper urinary tract stones

Objective  To investigate the effects of standard channel percutaneous nephrolithotomy(SPCNL) combined with flexible ureteroscopic holmium laser lithotripsy(FURS) on stone clearance,renal function and hemodynamics in patients with upper urinary tract stones.Methods  From March 2017 to June 2019,84 cases of hospitalized patients with urinary stones,refer to the random number table method who were divided into two groups, one group as the control group,another group to group,each group with 42 cases,the former channel use standard percutaneous nephrolithotomy treatment,after the channel combination standard percutaneous nephrolithotomy with soft ureter mirror holmium laser lithotripsy treatment.Renal function indexes(2-microglobulin,creatinine,urea) and hemodynamic indexes(central venous pressure,mean arterial pressure and heart rate) before and after surgery were compared with postoperative stone clearance rate,operation time,indwelling time of renal fistula, hospitalization time and incidence of complications.Results  There was no difference in preoperative renal function and hemodynamic indexes between the two groups(P>0.05).Compared with the preoperative level,the postoperative renal function indexes of the two groups were higher(P<0.05), and the hemodynamic indexes showed no difference(P>0.05).There was no difference in postoperative renal function,hemodynamics and complication rate between the two groups(P>0.05).Compared with the control group, the study group had higher postoperative stone clearance rate, longer operation time,shorter indwelling time and hospital stay for renal fistula(P<0.05).Conclusions  Percutaneous nephrolithotomy combined standard channel soft ureter mirror holmium laser lithotripsy on the treatment of urinary stones,though the joint operation of operation time is longer than standard channel percutaneous nephrolithotomy alone,but the postoperative calculi clearance rate is higher,and less effect on the patients with hemodynamic indexes, which can effectively improve renal function,further to promote patients' rapid recovery.