Study on the Effect of Percutaneous Nephroscopy Combined with Flexible Ureteroscopy in the Treatment of Ureteral Calculi with Ipsilateral Renal Calculi
Objective To analyze the application advantages of percutaneous nephrolithotomy(PCNL)combined with retrograde intrarenal surgery(RIRS)in the treatment of patients with ureteral calculi complicated with ipilateral renal cal-culi.Methods From January 2020 to January 2023,150 patients with ureteral calculi combined with ipilateral renal calculi were randomly divided into two groups,with 75 cases in each group.PCNL was performed in the nephroscopy group,and PCNL combined with RIRS was performed in the PCNL + RIRS group.Perioperative indicators,incidence of postoperative complication rate,postoperative visual analogue scale(VAS)score and incidence of abnormal urine metabolism were com-pared between the two groups.Preoperative and postoperative neurogenic inflammatory response indicators[nerve growth factor(NGF),prostaglandin E2(PGE2),C-reactive protein(CRP),Substance P(SP)],renal function indicators[serum creati-nine(Cr),UREA,kidney injury molecule 1(KIM-1),neutrophil gelatinase-associated apolipoprotein(NGAL)]were com-pared between the two groups.Results The duration of operation and hospitalization days of the PCNL + RIRS group were shorter than those of the nephroscopy group,the amount of intraoperative blood loss was lower than that of the nephroscopy group,and the stone clearance rate at 3 days and 1 month after the operation was higher than that of the nephroscopy group(P<0.01).The incidence of postoperative complications was 2.67%(2/75)in the PCNL +RIRS group,which was lower than that[12.00%(9/75)]in the nephroscopy group(P<0.05).The VAS scores at 6,12,24 and48 h after operation in the PCNL + RIRS group were lower than those in the nephroscopy group(P<0.05).NGF,PGE2,CRP and SP in the PCNL +RIRS groups were lower than those in the nephroscopy group at 24 and 48 h after surgery(P<0.05).Cr,UREA,KIM-1 and NGAL in the PCNL +RIRS group were lower than those in the nephroscopy group at 1 and 2 weeks after surgery(P<0.05).The incidence of hyperuricuria,hyperoxaluria,hypocitrouria,hypercalcemia and hypomagnesia at 2 weeks after surgery in the PCNL +RIRS group was lower than that in the nephroscopy group(P<0.05).Conclusion PCNL combined with RIRS in the treatment of patients with ureteral calculi combined with ipilateral renal calculi can optimize the operation,inhibit neurogenic inflammatory response,alleviate postoperative pain and renal function injury,increase stone clearance rate,reduce the risk of complications,and improve urine metabolic status.
万方数据
维普
