Analysis of the clinical efficacy of assisted visual ultra-micro channel percutaneous nephroscope in the treatment of complex lower calyceal calculus
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摘要: 目的 分析辅助可视超微通道经皮肾镜取石术治疗复杂性肾下盏结石的临床疗效。方法 将2019年1月—2020年11月宝鸡市人民医院收治的110例复杂性肾下盏结石患者按照不同的手术方式分为传统组(55例)和超微组(55例)，其中传统组给予传统微通道经皮肾镜取石术治疗，超微组给予辅助可视超微通道经皮肾镜取石术治疗。比较两组患者手术时间、住院时间、住院费用、肾造瘘留置时间、结石清除率及术后血红蛋白下降情况，血清β2-微球蛋白(β2-MG)水平、肾损伤情况[肾损伤因子-1(KIM-1)]以及术后并发症发生情况。结果 与传统组比较，超微组手术时间、住院时间、肾造瘘留置时间、术后血红蛋白下降值均明显降低(P< 0.05)，结石清除率明显升高(P< 0.05)；与术前比较，两组治疗后血清β2-MG水平均明显升高(P< 0.05)，但超微组明显低于传统组(P< 0.05)；超微组术后24 h、48 h、72 h KIM-1水平均明显低于传统组(P< 0.05)；两组患者住院费用及术后并发症发生率比较差异无统计学意义(P>0.05)。结论 辅助可视超微通道经皮肾镜治疗复杂性肾下盏结石可有效缩短手术时间、住院时间及肾造瘘留置时间，减轻肾功能损伤，提高结石清除率，安全有效。
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关键词:
- 复杂性肾下盏结石 /
- 辅助可视超微通道经皮肾镜 /
- 肾功能 /
- 肾损伤因子-1
Abstract: Objective To analyze the clinical efficacy of assisted visual ultra-micro channel percutaneous nephroscope in the treatment of complex lower calyceal calculus.Methods From Jan. 2019 to Nov. 2020, a total of 110 patients with complex lower calyceal calculus in Baoji People's Hospital were divided into traditional group (55 cases) and ultra-micro group (55 cases) according to different surgical methods. Among them, the traditional group was treated with traditional micro-channel percutaneous nephrolithotomy, and the ultra-micro group was treated with auxiliary visual ultra-micro channel percutaneous nephrolithotomy. The operation time, hospitalization time, hospitalization cost, indwelling time of nephrostomy tube, stone clearance rate and postoperative hemoglobin decline, serum β2-microglobulin (β2-MG), kidney injury [kidney injury factor-1 (KIM-1)] and postoperative complications were compared between the two groups.Results Compared with the traditional group, the operation time, hospitalization time, indwelling time of nephrostomy tube, and postoperative hemoglobin decline in the ultra-micro group significantly reduced (P< 0.05), and the stone clearance rate significantly increased (P< 0.05). The serum β2-MG levels in the two groups significantly increased after treatment compared with those before operation (P< 0.05), but compared with the traditional group, the ultra-micro group was significantly lower (P< 0.05). The level of KIM-1 at 24 h, 48 h, and 72 h after operation in the ultra-micro group were significantly lower than those in the traditional group (P< 0.05). There was no significant difference in the incidence of postoperative complications or hospitalization expenses between the two groups (P> 0.05).Conclusion Auxiliary visual ultra-micro channel percutaneous nephroscope for the treatment of complex lower calyceal calculus can effectively shorten the operation time, hospital stay and indwelling time of nephrostomy tube, reduce renal function damage, and increase the stone clearance rate, so it is safe and effective. -
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表 表 1 两组患者基本资料比较
例，X±S 组别 例数 年龄/岁 男/女 结石部位(单侧/双侧) 结石类型(鹿角型/多发性) 肾积水程度(轻度/无) 结石大小/cm 超微组 55 47.12±5.01 25/30 21/34 23/32 20/35 2.62±0.41 传统组 55 47.89±5.12 28/27 18/37 26/29 23/32 2.67±0.45 χ2/t - 0.797 0.328 0.358 0.331 0.344 0.609 P值 - 0.427 0.567 0.550 0.565 0.558 0.544 
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表 表 2 两组手术情况比较
例(%)，X±S 组别 例数 手术时间/min 住院时间/d 住院费用/万元 肾造瘘留置时间/d 结石清除率/% 术后血红蛋白下降情况/(g·L-1) 超微组 55 64.75±3.67 6.01±1.23 1.52±0.57 2.21±0.46 94.55(52/55) 10.01±2.13 传统组 55 75.14±4.78 7.36±1.57 1.58±0.61 3.54±0.58 78.18(43/55) 12.34±2.34 t - 12.786 5.020 0.533 13.324 4.940 5.461 P值 - 0 0 0.595 0 0.026 0
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表 表 3 两组血清β2-MG、KIM-1水平比较
X±S 分组 例数 β2-MG/(mg·L-1) KIM-1/(ng·L-1) 术前 术后 术前 术后24 h 术后48 h 术后72 h 超微组 55 4.15±0.78 4.67±1.011) 248.75±10.78 489.57±8.45 523.14±9.78 478.26±7.61 传统组 55 4.21±0.82 5.26±1.231) 247.56±10.64 578.62±11.78 615.41±12.57 589.67±8.64 t - 0.398 2.749 0.583 45.554 42.966 71.762 P值 - 0.695 0.007 0.561 0 0 0 与同组术前相比，1)P < 0.05。
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表 表 4 两组术后并发症发生情况比较
例(%) 组别 例数 发热 膀胱积血 出血 感染 术后并发症发生情况 超微组 55 0 2(3.64) 1(1.82) 1(1.82) 4(7.27) 传统组 55 1(1.82) 3(5.45) 1(1.82) 2(3.57) 7(12.73) χ2 - - - - - 0.909 P值 - - - - - 0.340
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