Application value of contrast-enhanced ultrasonography combined with PCNL in the treatment of renal calculi without hydronephrosis
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摘要: 目的 探讨超声造影联合经皮肾镜取石术(PCNL)在无积水肾结石治疗中的应用价值。方法 选取2020年1月—2021年10月在陆军第八十二集团军医院治疗的无积水肾结石患者98例，分为观察组(50例)和对照组(48例)，观察组给予超声造影联合PCNL治疗，对照组给予常规超声联合PCNL治疗。观察2组手术时间、术中出血量、Ⅰ期结石清除率等，同时检测手术前后白细胞计数(WBC)、血肌酐(Scr)、胱抑素C(Cys-C)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)和肾脏损伤分子-1(KIM-1)。结果 观察组穿刺时间、穿刺次数≥2次比例明显少于对照组[(8.80±1.84) minvs.(10.90±1.95) min，22.00%vs.47.92%，P< 0.05]；观察组和对照组手术时间、术中出血量比较差异无统计学意义(P>0.05)。观察组Ⅰ期结石清除率明显高于对照组(90.00%vs.72.92%，P< 0.05)，术后住院时间、术后3 d视觉模拟评分(VAS)明显低于对照组[(9.04±1.50) dvs.(11.80±1.89) d，(2.20±0.67)分vs.(4.05±0.80)分，P< 0.05]。观察组和对照组手术前后WBC、Scr比较差异无统计学意义(P＞0.05)；观察组术后3 d时Cys-C、NGAL和KIM-1明显低于对照组[(619.29±68.81) mg/Lvs.(690.05±70.59) mg/L，(4.04±0.98) mg/Lvs.(4.80±0.91) mg/L，(84.82±12.20) ng/Lvs.(95.52±12.67) ng/L，P< 0.05]。观察组术后并发症发生率明显低于对照组(10.00%vs.27.08%，P< 0.05)。结论 超声造影联合PCNL在无积水肾结石治疗中有较好的价值，值得临床使用。Abstract: Objective To investigate the value of contrast-enhanced ultrasound combined with percutaneous nephrolithotomy (PCNL) in the treatment of renal calculi without hydronephrosis.Methods From January 2020 to October 2021, 98 patients with renal calculi without hydronephrosis treated in our hospital were divided into observation group (n=50) and control group (n=48). The observation group was treated with contrast-enhanced ultrasound combined with PCNL, and the control group was treated with conventional ultrasound combined with PCNL. The operation time, intraoperative bleeding and phase Ⅰ stone clearance and so on of the two groups were observed, and the white blood cell (WBC) count, serum creatinine (Scr), Cystatin C (Cys-C), neutrophil gelatinase associated lipid carrier protein (NGAL) and kidney injury molecule-1 (KIM-1) before and after operation were measured.Results Puncture time and the proportion of puncture times≥2 in the observation group were significantly less than those in the control group [(8.80±1.84) minvs.(10.90±1.95) min, 22.00%vs.47.92%,P< 0.05]. There was no significant difference in operation time or intraoperative bleeding between the observation group and the control group (P> 0.05). The phase Ⅰ stone clearance rate in the observation group was significantly higher than that in the control group(90.00%vs.72.92%,P< 0.05). The postoperative hospital stay and 3 d visual analogue (VAS) scores were significantly lower than those in the control group [(9.04±1.50) dvs.(11.80±1.89) d, (2.20±0.67)scoresvs.(4.05±0.80)scores,P< 0.05]. There was no significant difference in WBC or Scr between the observation group and the control group before and after operation (P> 0.05). The Cys-C, NGAL and KIM-1 in the observation group at 3 d after operation were significantly lower than those in the control group [(619.29±68.81) mg/Lvs.(690.05±70.59) mg/L, (4.04±0.98) mg/Lvs.(4.80±0.91) mg/L, (84.82±12.20) ng/Lvs.(95.52±12.67) ng/L,P< 0.05]. The incidence of postoperative complications in the observation group was significantly lower than that in the control group (10.00%vs.27.08%,P< 0.05).Conclusion Contrast-enhanced ultrasound combined with PCNL has good value in the treatment of renal calculi without hydronephrosis, so it's worthy of clinical use.
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表 1 观察组和对照组一般资料比较
例(%)，X±S 组别 例数 年龄/岁 性别 BMI 肾结石长径/cm 结石类型 男 女 多发性 单纯性 鹿角形 观察组 50 50.05±9.92 39(78.00) 11(22.00) 22.38±2.01 3.54±0.60 29(58.00) 14(28.00) 7(14.00) 对照组 48 49.82±8.89 35(72.92) 13(27.08) 22.65±1.99 3.61±0.58 27(56.25) 16(33.33) 5(10.42) t/χ2 0.121 0.342 -0.668 -0.587 0.497 P 0.904 0.559 0.506 0.559 0.780 
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表 2 2组手术情况比较
例(%)，X±S 组别 例数 手术时间/min 穿刺时间/min 穿刺次数≥2次 术中出血量/mL 观察组 50 85.10±12.21 8.80±1.84 11(22.00) 40.30±12.12 对照组 48 88.40±13.32 10.90±1.95 23(47.92) 38.82±9.96 t/χ2 -1.279 -5.485 7.260 0.659 P 0.204 < 0.001 0.007 0.512
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表 3 2组Ⅰ期结石清除、住院时间和VAS评分比较
例(%)，X±S 组别 例数 Ⅰ期结石清除 术后住院时间/d 术后3 d VAS评分/分 观察组 50 45(90.00) 9.04±1.50 2.20±0.67 对照组 48 35(72.92) 11.80±1.89 4.05±0.80 t 4.767 -8.024 -12.430 P 0.029 < 0.001 < 0.001
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表 4 2组手术前后血清指标比较
X±S 指标 观察组(n=50) 对照组(n=48) t P WBC/(×109·L-1) 术前 6.20±1.43 6.11±1.54 0.300 0.765 术后3 d 8.44±1.32 8.51±1.30 -0.264 0.792 Scr/(mmol·L-1) 术前 86.60±12.33 86.10±11.82 0.205 0.838 术后3 d 87.19±11.82 86.89±12.54 0.122 0.903 Cys-C/(mg·L-1) 术前 520.16±70.54 515.58±68.88 0.325 0.746 术后3 d 619.29±68.81 690.05±70.56 -5.026 < 0.001 NGAL/(mg·L-1) 术前 3.45±0.80 3.50±0.89 -0.293 0.770 术后3 d 4.04±0.98 4.80±0.91 -3.974 < 0.001 KIM-1/(ng·L-1) 术前 77.14±13.32 75.59±12.05 0.603 0.548 术后3 d 84.82±12.20 95.52±12.67 -4.259 < 0.001
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表 5 2组术后并发症比较
例(%) 组别 例数 尿路感染 发热 膀胱刺激征 肾盂肾炎 合计 观察组 50 1(2.00) 2(4.00) 1(2.00) 1(2.00) 5(10.00) 对照组 48 2(4.17) 5(10.42) 3(6.25) 3(6.25) 13(27.08) χ2 4.767 P 0.029
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