Comparison of ultrasound-guided needle nephroscopy combined with standard channel and multi-channel percutaneous nephrolithotomy in the treatment of renal calculus
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摘要: 目的 比较超声引导下针状肾镜联合标准通道与多通道经皮肾镜取石术(PCNL)治疗肾结石的效果。方法 回顾性分析2019年5月—2020年8月郑州市第一人民医院收治的98例肾结石患者的临床资料，其中行超声引导下多通道PCNL治疗49例(对照组)，行超声引导下针状肾镜术联合标准通道PCNL治疗49例(观察组)。比较两组患者手术各项指标(手术时间、术中出血量、住院时间、住院费用)、术后疼痛程度、结石清除率、炎性因子、术后并发症发生率。结果 观察组手术各项指标和术后炎性因子水平均明显优于对照组，住院费用高于对照组(P< 0.05)。术后观察组视觉模拟评分法(VAS)评分低于对照组(P< 0.05)。观察组和对照组结石清除率分别为95.92%、91.84%，差异无统计学意义(P>0.05)。观察组术后并发症发生率低于对照组(P< 0.05)。多因素logistic回归分析结果显示，手术时间、VAS评分及术后超敏C-反应蛋白、降钙素原、血红蛋白水平与针状肾镜术联合标准通道PCNL治疗肾结石患者的效果相关(P< 0.05)。结论 在超声引导下，多通道PCNL和针状肾镜术联合标准通道PCNL均可有效地清除肾结石，但超声引导下针状肾镜术联合标准通道PCNL能更有效地改善手术各项指标，减轻术后疼痛程度，降低术后炎症反应和并发症发生率，是较为理想的手术方法。
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关键词:
- 针状肾镜 /
- 多通道经皮肾镜取石术 /
- 肾结石 /
- 结石清除率
Abstract: Objective To compare the effects of ultrasound-guided needle nephroscopy combined with standard channel and multi-channel percutaneous nephrolithotomy in the treatment of renal calculus.Methods A retrospective analysis was performed on 98 patients with renal calculus admitted to Zhengzhou First People's Hospital from May 2019 to August 2020. The control group (49 cases) received ultrasound-guided multi-tract percutaneous nephrolithotomy, and the observation group (49 cases) received ultrasound-guided needle nephroscopy combined with standard percutaneous nephrolithotomy. The surgical indicators (operating time, intraoperative blood loss, hospitalization time and hospitalization cost), postoperative pain, stone removal rate, inflammatory factors and postoperative complications were compared between the two groups.Results The indexes of operation and the level of postoperative inflammatory factors in the observation group were significantly better than those in the control group, but the hospitalization cost was higher than that in the control group(P< 0.05). The Visual Analogue Scale (VAS) score of the observation group was lower than that of the control group (P< 0.05). The stone removal rates of the observation group and the control group were 95.92% and 91.84%, respectively, and the difference was not statistically significant (P> 0.05). The postoperative complication rate was lower in the observation group than in the control group (P< 0.05). Multivariate Logistic regression analysis showed that the operation time, VAS score, postoperative high-sensitivity C-reactive protein, procalcitonin and hemoglobin levels were correlated with the effect of needle nephroscopy combined with standard channel percutaneous nephrolithotomy in the treatment of renal calculus (P< 0.05).Conclusion Under the guidance of ultrasound, multi-channel percutaneous nephrolithotomy and needle nephroscopy combined with standard channel percutaneous nephrolithotomy can effectively remove renal calculus, but ultrasound-guided needle nephroscopy combined with standard channel percutaneous nephrolithotomy can more effectively improve various surgical indexes, reduce the degree of postoperative pain and reduce the incidence of postoperative inflammatory reaction and complications. It is an ideal surgical method. -
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表 表 1 两组一般资料比较
例(%)，X±S 组别 性别 年龄/岁 体重指数/ (kg·m-2) 结石位置 结石直径/cm CT值/HU 男 女 左侧 右侧 对照组 28(57.14) 21(42.86) 47.61±5.38 21.07±2.38 22(44.90) 27(55.10) 0.76±0.21 790.46±112.25 观察组 30(61.22) 19(38.78) 47.53±5.25 21.15±2.45 24(48.98) 25(51.02) 0.70±0.19 801.39±106.73 χ2/t 0.169 0.074 0.164 0.164 1.483 0.494 P值 0.681 0.941 0.870 0.686 0.141 0.622 
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表 表 2 两组患者各项手术指标比较
X±S 组别 例数 手术时间/min 住院时间/d 术中出血量/mL 住院费用/千 对照组 49 62.42±9.26 15.03±3.52 42.16±8.85 14.03±2.13 观察组 49 41.37±6.14 5.27±1.31 11.98±2.54 15.07±2.32 t - 13.262 18.190 22.945 2.311 P值 - < 0.001 < 0.001 < 0.001 0.023
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表 表 3 两组患者VAS评分和结石清除率比较X±S
组别 例数 VAS评分/分 结石清除率/例(%) 对照组 49 6.31±1.07 45(91.84) 观察组 49 4.55±0.87 47(95.92) t - 8.934 0.178 P值 - < 0.001 0.673
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表 表 4 两组患者术前及术后炎症指标比较
X±S 组别 例数 超敏C-反应蛋白/ (mg·L-1) 降钙素原/ (ng·L-1) 白细胞介素-10/ (ng·L-1) 血红蛋白/ (g·L-1) 术前 术后 术前 术后 术前 术后 术前 术后 对照组 49 3.11±0.98 17.09±5.261) 0.48±0.15 0.81±0.241) 5.63±1.57 25.27±7.851) 1.18±0.26 0.64±0.051) 观察组 49 3.20±1.01 14.45±4.571) 0.47±0.13 0.60±0.191) 5.51±1.53 21.03±6.261) 1.24±0.35 0.93±0.131) t - 0.448 2.652 0.353 4.802 0.383 2.956 0.963 14.575 P值 - 0.655 0.009 0.725 < 0.001 0.702 0.004 0.338 0.014 与术前比较，1)P < 0.05。
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表 表 5 两组患者术后并发症发生率比较
例(%) 组别 例数 泌尿系统感染 尿漏 发热 总计 对照组 49 6(12.24) 2(4.08) 5(10.20) 13(26.53) 观察组 49 2(4.08) 1(2.04) 1(2.04) 4(8.16) χ2 - - - - 5.765 P值 - - - - 0.016
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表 表 6 影响针状肾镜术联合标准通道PCNL治疗肾结石效果的多因素分析
影响因素 β SE Wald χ2 P值 OR值 95%CI 手术时间 0.533 0.259 4.235 0.040 1.704 1.026~2.831 住院时间 0.199 0.194 1.051 0.305 1.220 0.834~1.784 术中出血量 0.341 0.183 3.467 0.063 1.406 0.982~2.013 住院费用 0.208 0.175 1.410 0.235 1.231 0.874~1.735 VAS评分 0.688 0.300 5.254 0.022 1.989 1.105~3.581 并发症 0.314 0.214 2.154 0.142 1.369 0.900~2.082 超敏C-反应蛋白 1.348 0.417 10.455 0.001 3.851 1.701~8.720 降钙素原 1.119 0.395 8.026 0.005 3.062 1.412~6.641 白细胞介素-10 0.538 0.287 3.517 0.061 1.713 0.976~3.006 血红蛋白 0.860 0.281 9.365 0.002 2.363 1.362~4.099
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