标题：经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石疗效观察

      作者：袁文兵，李正义，刘双宁，刘玮    宝鸡市人民医院泌尿外科，陕西 宝鸡 721000

      卷次： 2019年30卷22期

      【摘要】 目的 观察经皮肾镜联合输尿管软镜狄激光碎石术治疗复杂性肾结石的临床疗效。方法 选择2016年5月至2018年7月宝鸡市人民医院泌尿外科收治的220例复杂性肾结石患者，按随机数表法分为观察组和对照组，每组 110例，对照组患者采用经皮肾镜碎石术治疗，观察组患者在对照组治疗的基础上联合输尿管软镜狄激光碎石术治疗。比较两组患者的围术情况、肾功能、结石清除情况及并发症，全部患者均在术后 1个月复查。结果 观察组患者的手术时间和术中出血量分别为(128.51±14.62) min、(145.33±17.04) mL，均明显高于对照组的(113.74±15.13) min、(136.28±19.52) mL，住院时间为(6.45±1.47) d，明显少于对照组的(10.29±1.33) d，差异均具有统计学意义(P<0.05)；观察组患者的血清肌酐(Scr)、尿素氮(BUN)水平、尿β2-微球蛋白(β2-MG)分别为(83.60±13.58) μmol/L、(6.44±2.13) mmol/L、(3.18±0.49) mg/L，均明显低于对照组的(95.09±13.41) μmol/L、(8.29±2.20) mmol/L、(4.52±0.57) mg/L，差异均有统计学意义(P<0.05)；观察组患者的结石清除率为96.36%，明显高于对照组的85.45%，术后并发症总发生率为1.82%，明显低于对照组的10.91%，差异均有统计学意义(P<0.05)。结论 经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石具有创伤小、住院时间短、并发症少、安全可靠的特点，值得临床中推广应用。
      【关键词】 经皮肾镜；输尿管软镜；钬激光碎石术；复杂性肾结石；疗效
      【中图分类号】 R692.4 【文献标识码】 A 【文章编号】 1003—6350（2019）22—2915—04

Therapeutic effect of percutaneous nephrolithotomy combined with ureteroscopy-guided holmium laserlithotripsy in the treatment of complicated renal calculi.
YUAN Wen-bing, LI Zheng-yi, LIU Shuang-ning, LIU Wei.Department of Urology, Baoji People's Hospital, Baoji 721000, Shaanxi, CHINA
【Abstract】 Objective To assess the clinical effect of percutaneous nephrolithotripsy (PCNL) combined withureteroscopy-guided holmium laser lithotripsy in the treatment of complex renal calculi. Methods A total of 220 pa-tients with complex renal calculi, who admitted to Department of Urology, Baoji People's Hospital from May 2016 to Ju-ly 2018, were selected and divided into the observation group and control group according to random number table meth-od, with 110 cases in each group. The control group was treated with PCNL, and the observation group was treated withflexible ureteroscopy and holmium laser lithotripsy on the basis of the control group. The perioperative situation, renalfunction, stone clearance and complications of the two groups were compared. All patients were reexamined one monthafter operation. Results The operation time and intraoperative bleeding volume in the observation group were (128.51±14.62) min, (145.33±17.04) mL, respectively, which were significantly higher than corresponding (113.74±15.13) minand (136.28±19.52) mL in the control group, and hospitalization time was (6.45±1.47) d versus (10.29±1.33) d (all P<0.05); the levels of serum creatinine (Scr), urea nitrogen (BUN), and urinary β2-microglobulin (β2-MG) in the observa-tion group were (83.60±13.58) μmol/L, (6.44±2.13) mmol/L, (3.18±0.49) mg/L, respectively, which were significantlylower than corresponding (95.09±13.41) μmol/L, (8.29±2.20) mmol/L, (4.52±0.57) mg/L in the control group (all P<0.05); the stone clearance rate of the observation group was 96.36%, which was significantly higher than 85.45% of thecontrol group (P<0.05); the total incidence of postoperative complications in the observation group was 1.82% versus10.91% in the control group (P<0.05). Conclusion In the treatment of complex renal calculi, the combined use of per-cutaneous nephrolithotomy and holmium laser lithotripsy under flexible ureteroscope has the characteristics of less trau-ma, shorter hospitalization time, fewer complications, good safety and reliability, which is worth popularizing and apply-ing in clinic.
      【Key words】 Percutaneous nephrolithotomy; Flexible ureteroscope; Holmium laser lithotripsy; Complex renalcalculi; Curative effect