[1]周真文,毕满华,蒋　方,等.经皮肾镜碎石术与经尿道输尿管软镜碎石术治疗肾结石疗效比较[J].新乡医学院学报,2021,38(3):289-292.[doi:10.7683/xxyxyxb.2021.03.018]
　ZHOU Zhenwen,BI Manhua,JIANG Fang,et al.Comparison of the effect between percutaneous nephrolithotomy and transurethral flexible ureteroscopic lithotripsy in the treatment of renal calculus[J].Journal of Xinxiang Medical University,2021,38(3):289-292.[doi:10.7683/xxyxyxb.2021.03.018]
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经皮肾镜碎石术与经尿道输尿管软镜碎石术治疗肾结石疗效比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
38
期数:
2021年3
页码:
289-292
栏目:
临床研究
出版日期:
2021-03-05

文章信息/Info

Title:
Comparison of the effect between percutaneous nephrolithotomy and transurethral flexible ureteroscopic lithotripsy in the treatment of renal calculus
作者:
周真文; 毕满华; 蒋　方; 金能成; 郭志文
（安庆市第一人民医院泌尿外科，安徽　安庆　246003）
Author(s):
ZHOU Zhenwen; BI Manhua; JIANG Fang; JIN Nengcheng; GUO Zhiwen
(Department of Urinary Surgery,Anqing First People′s Hospital,Anqing 246003,Anhui Province,China)
关键词:
肾结石; 经皮肾镜碎石术; 输尿管软镜碎石术; 肾功能; 应激反应; 炎症因子
Keywords:
renal calculus percutaneous nephrolithotomy transurethral flexible ureteroscopic lithotripsy renal function stress response inflammatory factor
分类号:
R692.4
DOI:
10.7683/xxyxyxb.2021.03.018
文献标志码:
A
摘要:
目的　比较经皮肾镜碎石术与经尿道输尿管软镜碎石术治疗肾结石的临床效果。方法　选择2017年1月至2019年12月安庆市第一人民医院收治的80例肾结石患者为研究对象，按照手术方法将患者分为观察组和对照组，每组40例。对照组患者采用经皮肾镜碎石术，观察组患者采用经尿道输尿管软镜碎石术。对2组患者结石清除率、术中出血量、手术时间、住院时间、并发症及血肌酐（Scr）、血尿氮素（BUN）、促肾上腺皮质激素 （ACTH）、肾上腺素（AD）、去甲肾上腺素（NE）、C反应蛋白（CRP）、白细胞介素-10（IL-10）水平和白细胞（WBC）计数进行比较。结果　观察组和对照组患者结石清除率分别为90.00%（36/40）、92.50%（37/40），2组患者结石清除率比较差异无统计学意义（χ2=0.157，P＞0.05）。观察组患者术中出血量少于对照组，手术时间长于对照组，住院时间短于对照组（P＜0.05）。2组患者术前Scr、BUN水平比较差异无统计学意义（P＞0.05），2组患者术后Scr、BUN水平显著高于术前（P＜0.05），观察组患者术后Scr、BUN水平显著低于对照组（P＜0.05）。2组患者术前血清ACTH、AD、NE水平比较差异无统计学意义（P＞0.05），2组患者术后血清ACTH、AD、NE水平显著高于术前（P＜0.05），观察组患者术后血清ACTH、AD、NE水平显著低于对照组（P＜0.05）。2组患者术前血清CRP、IL-10水平及WBC计数比较差异无统计学意义（P＞0.05），2组患者术后血清CRP、IL-10水平及WBC计数显著高于术前（P＜0.05），观察组患者术后血清CRP、IL-10水平及WBC计数显著低于对照组（P＜0.05）。观察组和对照组患者并发症发生率分别为7.50%（3/40）、25.00%（10/40），观察组患者并发症发生率显著低于对照组（χ2=4.501，P＜0.05）。结论　经皮肾镜碎石术和经尿道输尿管软镜碎石术治疗肾结石均可取得较高的结石清除率，但经尿道输尿管软镜碎石术术中出血量少、应激反应和炎症反应弱、对患者肾功能损伤小，且并发症发生率低，有利于患者术后快速恢复。
Abstract:
Objective　To compare the clinical effect of percutaneous nephrolithotomy and transurethral flexible ureteroscopic lithotripsy in the treatment of renal calculus.Methods　Eighty patients with renal calculus admitted to Anqing First People′s Hospital from January 2017 to December 2019 were selected as the research subjects,and the patients were divided into observation group and control group according to surgical methods,with forty cases in each group.The patients in the control group were treated with percutaneous nephrolithotomy,while the patients in the observation group were treated with transurethral flexible ureteroscopic lithotripsy.The stone clearance rate,intraoperative blood loss,operation time,hospitalization time,complications and the levels of serum creatinine (Scr),blood urea nitrogen (BUN),adrenocorticotropic hormone (ACTH),adrenaline (AD),norepinephrine (NE),C-reactive protein (CRP),interleukin-10 (IL-10),white blood cell(WBC) count were compared between the two groups.Results　The stone clearance rate in the observation group and the control group was 90.00% (36/40) and 92.50% (37/40),respectively.There was no significant difference in the stone clearance rate between the two groups (χ2=0.157,P>0.05).Compared with the control group,the patients in the observation group had less blood loss,longer operation time and shorter hospitalization time (P＜0.05).There was no significant difference in the levels of Scr and BUN between the two groups before operation (P>0.05).The levels of Scr and BUN after operation were significantly higher than those before operation in the two groups (P＜0.05).The levels of Scr and BUN in the observation group were significantly lower than those in the control group after operation (P＜0.05).There was no significant difference in the levels of serum ACTH,AD and NE between the two groups before operation (P>0.05).The levels of ACTH,AD and NE after operation were significantly higher than those before operation in the two groups (P＜0.05).The levels of ACTH,AD and NE in the observation group were significantly lower than those in the control group after operation (P＜0.05).There was no significant difference in the levels of serum CRP,IL-10 levels and WBC count between the two groups before operation (P>0.05).The levels of serum CRP,IL-10 levels and WBC count after operation were significantly higher than those before operation in the two groups (P＜0.05).The levels of serum CRP,IL-10 levels and WBC count in the observation group were significantly lower than those in the control group after operation (P＜0.05).The incidence of complications in the observation group and the control group was 7.50% (3/40) and 25.00% (10/40),respectively.The incidence of complications in the observation group was significantly lower than that in the control group (χ2=4.501,P＜0.05).Conclusion　The percutaneous nephrolithotomy and transurethral flexible ureteroscopic lithotripsy in the treatment of renal calculi can achieve higher stone clearance rate.The transurethral flexible ureteroscopic lithotripsy has less blood loss,weak stress response and inflammatory response,less damage to renal function,and low incidence of complications,which is conducive to postoperative rapid recovery of patients.

参考文献/References:

［1］　罗继毅，李成山.输尿管软镜治疗肾结石的效果及对肾损伤因子、炎症因子表达水平的影响［J］.四川医学，2019，40（7）：702-706.
［2］　王磊，马玲，乔庆东，等.输尿管软镜碎石术和体外冲击波碎石术治疗小于20mm肾结石的临床疗效及影响因素分析［J］.新乡医学院学报，2019，36（12）：1141-1144.
［3］　杨立军，李海立，宋波.经皮肾镜碎石取石术与输尿管软镜碎石取石术治疗直径≤2 cm肾结石的临床效果比较［J］.中国综合临床，2018，34（4）：372-375.
［4］　陈晨，王臣，李子良，等.组合式输尿管软镜联合钬激光碎石术与经皮肾镜碎石术治疗肾结石对比研究［J］.河北医学，2018，24（8）：1358-1362.
［5］　翁依华，刘孙标，郭宪伟.经皮肾镜碎石术治疗复杂性肾结石的临床疗效及对患者肾功能的影响［J］.医学综述，2016，22（20）：4086-4089.
［6］　李卿英，武鹏，任宝明.输尿管软镜与经皮肾镜在肾结石患者中的疗效及对肾功能和凝血功能的影响［J］.血栓与止血学，2020，26（4）：655-657.
［7］　向芹，刘跃光，李文科，等.输尿管软镜碎石术和经皮肾镜碎石术 治疗肾结石的疗效及对机体应激反应的影响［J］.海南医学，2018，29（14）：1957-1959.
［8］　单勇，陈明，徐汉军，等.PCNL和RIRS治疗肾及输尿管上段结石的临床效果比较［J］.现代医学，2018，46（12）：1384-1387.
［9］　陈林俊，孙浩.不同微创手术对孤立肾结石患者血清细胞因子及肾功能的影响［J］.重庆医学，2020，49（6）：953-958.
［10］　吴维，江娟，吕磊，等.经皮肾镜钬激光碎石术对复杂性肾结石患者应激指标及肾功能的影响［J］.微创泌尿外科杂志，2018，7（2）：92-96.
［11］　周凯，陈珍霖，杨旭，等.输尿管软镜碎石术与经皮肾镜碎石术治疗肾结石的临床效果及对患者炎症反应、应激反应的影响［J］.现代生物医学进展，2020，20（15）：2896-2899，2938.

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更新日期/Last Update: 2021-03-05