摘要
目的比较一期单通道微创经皮肾镜取石术(minimally invasive percutaneous nephrolithotomy,MPCNL)与多通道MPCNL治疗复杂性肾结石的临床效果。方法回顾性分析2015年2月至2018年12月成都市第五人民医院收治的82例行一期MPCNL治疗的复杂性肾结石患者的临床资料,根据手术方法将其分为多通道组(43例)和单通道组(39例)。比较两组患者手术相关指标、术后并发症发生情况、围术期疼痛情况[视觉模拟评分法(visual analogue scale,VAS)]以及手术前后肾损伤指标[中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)、半胱氨酸蛋白酶抑制剂C(cystatin C,Cys C)、肾小球滤过率(glomerular filtration rate,GFR)]、应激反应指标[皮质醇(cortisol,Cor)、促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)]和血红蛋白(hemoglobin,Hb)水平。结果两组患者手术时间、术中出血量、术后各并发症发生率和总发生率比较差异均无统计学意义(均P>0.05);多通道组患者结石清除率显著高于单通道组(P<0.05),术后住院天数显著短于单通道组(P<0.05)。术后1 d和术后3 d,两组患者围术期VAS评分均显著高于本组术前(均P<0.05),但多通道组患者VAS评分均显著低于同期单通道组(均P<0.05)。术后1 d,两组患者血清NGAL、Cys C、Cor和ACTH水平均显著高于本组术前(均P<0.05),GFR和Hb水平均显著低于本组术前(均P<0.05);且单通道组患者血清NGAL、Cys C、Cor和ACTH水平均显著高于多通道组(均P<0.05),GFR显著低于多通道组(P<0.05),但两组间Hb水平比较差异无统计学意义(P>0.05)。结论与一期单通道MPCNL相比,一期多通道MPCNL能够提高复杂性肾结石患者的结石清除率,缩短住院天数,降低肾损伤风险,减轻应激反应,安全性较好。
Objective To compare the clinical effects of one-stage single-channel minimally invasive percutaneous nephrolithotomy(MPCNL)and multi-channel MPCNL in the treatment of complex renal calculus.Method The clinical data of 82 patients with complex renal calculus treated with one-stage MPCNL in Chengdu Fifth People's Hospital from February 2015 to December 2018 were analyzed retrospectively,they were divided into multi-channel group(n=43)and single-channel group(n=39)according to the surgical methods.The operation-related indexes,postoperative complications and perioperative pain[visual analogue scale(VAS)score]and renal injury indexes[neutrophil gelatinase-associated lipocalin(NGAL),cystatin C(Cys C),glomerular filtration rate(GFR)],stress response indexes[cortisol(Cor),adrenocorticotropic hormone(ACTH)]and hemoglobin(Hb)levels before and after operation were compared between the two groups.Result There were no significant differences in operation time,intraoperative blood loss,incidence of postoperative complications and total incidence between the two groups(all P>0.05).The stone clearance rate in multichannel group was significantly higher than that in single-channel group(P<0.05),and the postoperative hospital day in multichannel group was significantly shorter than that in single-channel group(P<0.05).The perioperative VAS scores of the two groups were significantly higher than those before operation in both groups at 1 day and 3 days after operation(all P<0.05),but the VAS scores in multi-channel group were significantly lower than those in single-channel group(all P<0.05).One day after operation,the serum levels of NGAL,Cys C,Cor and ACTH in both groups were significantly higher than those before operation(all P<0.05),GFR and Hb level in both groups were significantly lower than those before operation(all P<0.05);and the serum levels of NGAL,Cys C,Cor and ACTH in single-channel group were significantly higher than those in multi-channel group(all P<0.05),the GFR in single-channel group was significantly lower than that in multi-channel group(P<0.05),but there was no significant difference in the level of Hb between the two groups(P>0.05).Conclusion Compared with one-stage single-channel MPCNL,one-stage multi-channel MPCNL can improve the stone clearance rate of patients with complex renal calculus,shorten the hospital day,reduce the risk of renal injury and stress response,and have better safety.
作者
邓林
张力
李涵
王凯
Deng Lin;Zhang Li;Li Han;Wang Kai(Department of Urology,Chengdu Fifth People's Hospital,Chengdu 611130,China)
出处
《中国医学前沿杂志（电子版）》
2020年第7期182-186,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
复杂性肾结石
微创经皮肾镜取石术
单通道
多通道
Complicated renal calculus
Minimally invasive percutaneous nephrolithotomy
Single-channel
Multi-channel
