单通道PCNL联合输尿管软镜治疗老年复杂性肾结石疗效观察

摘要

目的 研究在老年复杂性肾结石患者中使用单通道经皮肾镜(PCNL)联合输尿管软镜(FURSL)治疗的有效性和安全性.方法 回顾性分析在医院行PCNL治疗的118例老年复杂性结石患者临床资料,其中行标准多通道PCNL治疗患者68例(对照组),行单通道PCNL联合FURSL治疗患者50例(观察组),比较两组的一期结石清除率、手术时间、住院时间、术中出血量及术后并发症等.结果 两组均顺利完成了手术,两组一期结石清除率无统计学差异(观察组85.7％,对照组的90.8％,P＞0.05).观察组手术时间明显短于对照组(64.4±9.7)min vs(82.9±12.6)min(P＜ 0.05),住院时间也短于对照组(5.8±1.2)d vs(7.9±1.8)d(P＜0.05);观察组术中出血量少于对照组(P＜0.05);术后两组肌酐均升高,但观察组升高程度较低(18.4±2.1) μmol/L vs(23.3±3.4)μmol/L(P＜ 0.05).观察组术后并发症发生率显著低于对照组(6.0％vs 19.1％,P＜0.05).结论 单通道PCNL联合FURSL治疗老年复杂性肾结石效果确切,术中出血少,对肾功能影响小,并发症少,患者术后恢复快,获益更多.%Objective To study the effects and safety of single-channel percutaneous nephrolithotomy (PCNL) combined with flexible ureteroscope (FURSL) in the treatment of complex renal calculi in senile patients.Methods The clinical data of 118 senile patients with complex renal calculi to receive PCNL in our hospital were analyzed retrospectively.These patients were divided into a control group (standard multi-channel PCNL,n=68) and an observation group (single-channel PCNL combined with FURSL,n=50).The rate of stone removal,operation time,length of stay (LOS),intraoperative blood loss and postoperative complications between the two groups were compared.Results The operation in the two groups was successfully completed.The rate of stone removal between the two groups had no significant difference (85.7％ in the observation group and 90.8％ in the control group,P ＞ 0.05).The operation time in the observation group was significantly shorter than that in the control group (64.4±9.7)min vs (82.9±12.6)min(P ＜ 0.05),and the LOS was also shorter than that in the control group (5.8±1.2)d vs (7.9±1.8)d (P ＜ 0.05);the intraoperative blood loss in the observation group was less than that in the control group (P ＜ 0.05);the creatinine in the two groups increased after the operation,but the increase in the observation group was less than that in the control group (18.4±2.1)μmol/L vs (23.3±3.4)μmol/L (P ＜ 0.05).The incidence of postoperative complications in the observation group was significantly lower than that in the control group(6.0％ vs 19.1％,P ＜ 0.05).Conclusion Single-channel PCNL combined with FURSL has good effects in the treatment of complex renal calculi in senile patients,causes less intraoperative blood loss,has minor impacts on renal function and fewer complications,and ensures quick post-operative recovery and more benefits to the patients.