Comparison of Combined Ureteroscopic Lithotripsy and Minimally Invasive Percutaneous Nephrolithotripsy in Upper Urinary Tract Calculi
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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.
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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