目的 对比组合式输尿管软镜碎石术(FURS)与微创经皮肾镜碎石术(PCNL)在上尿路结石(UUC)患者中的应用效果及对肾功能的影响.方法 选取2020年1月至2022年10月新乡医学院第三附属医院收治的92例UUC患者随机分为A组、B组,各46例,B组接受PCNL,A组接受FURS.对比两组围手术期指标、碎石成功率、手术前后肾功能[血尿素氮(BUN)、血肌酐(Scr)、明胶酶相关脂质运载蛋白(NGAL)]、应激指标[肾上腺素(AD)、促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)]、炎症反应指标[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)]、并发症发生率.结果 A组手术耗时较B组长,术中出血量较B组少,排气及住院时间较B组短(P＜0.05);术后2 d A组BUN、Scr、NGAL、AD、ACTH、NE、TNF-α、CRP、IL-6 水平较 B 组低(P＜0.05);A 组并发症发生率较 B 组低(P＜0.05).结论 FURS与PCNL在UUC中的碎石成功率相当,但FURS术中出血量较少,术后应激较小,同时对肾功能损伤较小,并发症发生率更低,更有助于患者术后恢复.
Comparison of Combined Ureteroscopic Lithotripsy and Minimally Invasive Percutaneous Nephrolithotripsy in Upper Urinary Tract Calculi
Objective To compare the application effect of combined flexible ureteroscopy(FURS)and minimally invasive percutaneous nephrolithotripsis(PCNL)in upper urinary tract calculi(UUC)patients and the effect on renal function.Methods Ninety-two patients with UUC in the Third Affiliated Hospital of Xinxiang Medical College from January 2020 to October 2022 were selected as research objects and randomly divided into group A and group B,with 46 cases in each group.Group B received PCNL and group A received FURS.Perioperative indexes,success rate of maclestone,renal function[blood urea nitrogen(BUN),serum creatinine(Scr),neutropil gelatinase-associated lipocalin(NGAL)],stress indexes[adrenalin(AD),adreno-cortico-tropic-hormone(ACTH),norepinephrine(NE)],inflammatory response indexes[tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),interleukin-6(IL-6)]before and after operation between the two groups and complication rate were compared.Results The operation time of group A was longer than that of group B,the amount of intraoperative blood loss was less,and the time of exhaust and hospitalization was shorter than that of group B(P＜0.05).Two days after surgery,the levels of BUN,Scr,NGAL,AD,ACTH,NE,TNF-α,CRP and IL-6 in group A were lower than those in group B(P＜0.05).The complication rate of group A was lower than that of group B(P＜0.05).Conclusion The lithotripsy success rates of FURS and PCNL in UUC are comparable,but FURS has less intraoperative bleeding and less postoperative stress,as well as less damage to renal function and a lower complication rate,which is more conducive to the patient's postoperative recovery.
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