摘要
目的 本研究探讨微创经皮肾镜取石术(PCNL)治疗肾结石合并慢性肾功能不全患者的临床效果及安全性,为该类特殊人群的手术方案选择提供参考依据。方法 本研究回顾性纳入2023年5月至2025年1月期间本院收治的肾结石合并慢性肾功能不全患者101例为研究对象,按不同手术治疗方法为观察组(n=49)和对照组(n=52),对照组行标准通道经皮肾镜取石术,观察组行施微创经皮肾镜取石术。比较手术指标、应激指标、肾损伤因子、结石清除率及并发症发生率。结果 两组患者的结石清除效果相近(P>0.05),但观察组在手术效率及术后恢复方面表现更优:观察组手术时长、出血量、肠道功能恢复情况及住院周期均较对照组缩短。此外,术后生化指标分析显示,观察组的应激指标(促肾上腺皮质激素、皮质醇、去甲肾上腺素)水平及肾功能相关标志物(胱抑素C、血肌酐和中性粒细胞明胶酶相关脂质运载蛋白)的升高幅度显著低于对照组,对比差异均有统计学意义(P<0.05)。在安全性方面,观察组术后并发症发生率更低,对比对照组差异有统计学意义(P<0.05)。结论 肾结石合并慢性肾功能不全患者的治疗中,相较于标准通道手术,经皮肾镜取石术能有效减少对肾实质的机械性损伤和术中出血。同时,其微创特性显著降低术后感染、出血等并发症的发生率,可提高手术安全性。
Objective To explore the clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy(PCNL)in the treatment of patients with renal calculi combined with chronic renal insufficiency.Methods A total of 101 patients with renal calculi combined with chronic renal insufficiency admitted to our hospital from May 2023 to January 2025 were retrospectively included.They were divided into the observation group(n=49)and the control group(n=52)based on different surgical treatment methods.The patinets in the control group were underwent standard-channel PCNL,while in the observation group underwent minimally invasive PCNL.The surgical indicators,stress indicators,renal injury factors,stone clearance rate,and complication rate were compared.Results The stone clearance effect was similar in both groups(P>0.05),but the observation group performed better in terms of surgical efficiency and postoperative recovery:the operation time,blood loss,intestinal function recovery,and hospital stay in the observation group were shorter than those in the control group.In addition,postoperative biochemical index analysis showed that the levels of stress indicators(adrenocorticotropic hormone,cortisol,and norepinephrine)and the increase in renal function-related markers(cystatin C,serum creatinine,and neutrophil gelatinase-associated lipocalin)in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).In terms of safety,the postoperative complication rate in the observation group was lower than that in the control group(P<0.05).Conclusion In the treatment of patients with renal calculi combined with chronic renal insufficiency,compared with standard-channel surgery,PCNL can effectively reduce mechanical damage to the renal parenchyma and intraoperative bleeding.At the same time,its minimally invasive nature significantly reduces the incidence of postoperative complications such as infection and bleeding,thereby improving the safety of the surgery.
作者
徐可欣
高嵩
XU Kexin;GAO Song(Lishui People's Hospital,Zhejiang 323000,China)
出处
《浙江创伤外科》
2025年第7期1222-1225,共4页
Zhejiang Journal of Traumatic Surgery
关键词
微创
经皮肾镜取石术
肾结石合并慢性肾功能不全
应激反应
肾损伤因子
Minimally invasive
Percutaneous nephrolithotomy
Renal calculi combined with chronic renal insufficiency
Stress response
Renal injury factors
