微创泌尿外科杂志

目的：分析复杂性肾结石患者接受微创经皮肾镜碎石取石术单独及联合输尿管软镜碎石取石术的临床效果。方法：本研究为前瞻性研究，选取宜宾市第二人民医院2020年1月至2022年8月收治的169例复杂性肾结石患者，依据随机数字表法将其分为经皮肾镜组(56例)、输尿管软镜组(57例)、联合组(56例)。各组均于术后随访2年。采用t检验或者χ²检验比较各组的临床疗效、手术相关指标，术前与术后24 h的肾功能及超敏C反应蛋白(hs-CRP)、肿瘤坏死因子(TNF)-α、血管紧张素(Ang)Ⅰ、AngⅡ水平，以及术后1个月、2年的并发症及术后7 d的结石清除情况。结果：与经皮肾镜组(69.64%)、输尿管软镜组(70.18%)比较，联合组的临床总有效率(92.86%)较高，差异有统计学意义(P<0.05)。联合组手术时间、碎石时间长于输尿管软镜组与经皮肾镜组，输尿管软镜组碎石时间长于经皮肾镜组，联合组排气时间及住院时间短于输尿管软镜组、经皮肾镜组，输尿管软镜组短于经皮肾镜组，差异均有统计学意义(P<0.05)。术后24h，各组患者的血清β2微球蛋白(BMG)、尿素氮(BUN)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、血肌酐(Scr)及尿肾损伤分子-1(KIM-1)水平与术前比较均升高，且联合组低于输尿管软镜组、经皮肾镜组(P<0.05)。术后24 h，各组患者血清hs-CRP、TNF-α、AngⅠ、AngⅡ水平均高于术前，且联合组低于输尿管软镜组、经皮肾镜组，差异均有统计学意义(P<0.05)。联合组结石清除率(89.29%)高于经皮肾镜组(64.29%)和输尿管软镜组(66.67%)，差异有统计学意义(P<0.05)。结论：微创经皮肾镜联合输尿管软镜碎石取石用于治疗复杂性肾结石在缓解炎症应激反应、保护肾功能、提高结石清除率方面更具优势。

Methods: A prospective study was conducted, enrolling 169 patients with complex renal calculi admitted to Yibin Second People's Hospital from January 2020 to August 2022. According to the random number table method, the patients were divided into the percutaneous nephrolithotomy group(56 cases), the flexible ureteroscope group(57 cases), and the combined group(56 cases). All groups were followed up for 2 years after surgery. The t-test or χ2 test was used to compare the clinical efficacy, surgery-related indicators, renal function, levels of high-sensitivity C-reactive protein(hs-CRP), tumor necrosis factor(TNF)-α, angiotensin(Ang) Ⅰ, and Ang Ⅱ at 24 hours before and after surgery, as well as complications at 1 month and 2 years after surgery and stone clearance at 7 days after surgery among the groups. Results: The total clinical effective rate of the combined group(92.86%) was higher than that of the percutaneous nephrolithotomy group(69.64%) and the flexible ureteroscope group(70.18%), with statistically significant differences(P<0.05). The operation time and lithotripsy time in the combined group were longer than those in the flexible ureteroscope group and the percutaneous nephrolithotomy group; the lithotripsy time in the flexible ureteroscope group was longer than that in the percutaneous nephrolithotomy group. The exhaust time and hospital stay in the combined group were shorter than those in the flexible ureteroscope group and the percutaneous nephrolithotomy group; the flexible ureteroscope group had shorter times than the percutaneous nephrolithotomy group, with statistically significant differences in all the above indicators(P<0.05). At 24 hours after surgery, the serum levels of β2-microglobulin(BMG), blood urea nitrogen(BUN), neutrophil gelatinase-associated lipocalin(NGAL), serum creatinine(Scr), and urinary kidney injury molecule-1(KIM-1) in all groups were increased compared with those before surgery, and the combined group had lower levels than the flexible ureteroscope group and the percutaneous nephrolithotomy group(P<0.05). At 24 hours after surgery, the serum levels of hs-CRP, TNF-α, Ang Ⅰ, and Ang Ⅱ in all groups were higher than those before surgery, and the combined group had lower levels than the flexible ureteroscope group and the percutaneous nephrolithotomy group, with statistically significant differences(P<0.05). The stone clearance rate in the combined group(89.29%) was higher than that in the percutaneous nephrolithotomy group(64.29%) and the flexible ureteroscope group(66.67%), with statistically significant differences(P<0.05). Conclusion: Minimally invasive percutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy and stone extraction has more advantages in alleviating inflammatory stress response, protecting renal function, and improving stone clearance rate in the treatment of complex renal calculi. Objective: To analyze the clinical efficacy of minimally invasive percutaneous nephrolithotomy(mPCNL) alone and in combination with flexible ureteroscopic lithotripsy(fURL) in the treatment of patients with complex renal calculi.