Efficacy analysis and safety evaluation of multi-endoscopy combination intrarenal surgery for complex renal calculi
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摘要:
目的 探讨经皮肾镜取石术（PCNL）联合输尿管软镜钬激光碎石术治疗复杂性肾结石的结石清除率及术后并发症等指标，评估其临床应用价值。 方法 回顾性分析2022年1月—2024年9月安徽医科大学第四附属医院收治的53例复杂性肾结石患者的临床资料，根据治疗方法分为PCNL组（对照组，27例）和多镜联合组（观察组，26例）。比较2组患者手术和住院时间、住院费用、一期结石清除率、通道个数、肾功能指标、出血感染指标、疼痛评分以及并发症发生情况等。 结果 观察组手术时间、住院时间、住院费用均低于对照组[（128.54±20.73）min vs.（160.81±28.24）min；（9.04± 2.52）d vs.（11.04±2.88）d；（1.78±0.19）万元vs.（2.02±0.31）万元]，且一期结石清除率更高[84.62%（22/26）vs. 55.56%（15/27）]，建立通道个数更少[（1.27±0.45）个vs.（2.37± 0.69）个]，差异均有统计学意义P＜0.05）。2组术前肌酐（Cr）、尿素氮（BUN）和β2-微球蛋白（β2-MG）差异均无统计学意义，术后差异均有统计学意义；观察组患者手术前后Hb、hs-CRP及PCT差值水平低于对照组（P＜0.05）；术后6 h，观察组患者VAS评分低于对照组（P＜0.05）；2组患者术后12 h及24 h VAS评分差异无统计学意义。观察组术后并发症总发生率低于对照组（P＜0.05）。 结论 经皮肾镜取石术联合输尿管软镜钬激光碎石术治疗复杂性肾结石能提高一期结石清除率，减少术后并发症，安全有效。 Abstract:Objective To investigate the stone-free rate, postoperative complications, and other indicators of percutaneous nephrolithotomy (PCNL) combined with flexible ureteroscopic holmium laser lithotripsy in the treatment of complex renal calculi, so as to evaluate its clinical application value. Methods The clinical data of 53 patients with complex renal calculi admitted to the Fourth Affiliated Hospital of Anhui University of Medicine from January 2022 to September 2024 were retrospectively analyzed. According to the treatment method, the patients were divided into a PCNL group (control group, n=27) and a multi-endoscopy combination group (observation group, n=26). The operation time, hospital stay, hospitalization costs, primary stone clearance rate, number of access tracts, renal function indicators, bleeding and infection indicators, pain scores, and complications were compared between the two groups. Results The average operation time, hospital stay, and hospitalization costs in the observation group were lower than those in the control group [(128.54±20.73) min vs. (160.81±28.24) min; (9.04±2.52) d vs. (11.04±2.88) d; (17 800±1 900) RMB vs. (20 200±3 100) RMB]. Additionally, the observation group had a higher primary stone clearance rate [84.62% (22/26) vs. 55.56% (15/27)] and fewer access tracts (1.27±0.45 vs. 2.37±0.69), with statistically significant differences (P < 0.05). There were no statistically significant differences in preoperative creatinine (Cr), blood urea nitrogen (BUN), and β2-microglobulin (β2-MG) between the two groups, but postoperative differences were statistically significant. The differences in Hb, hs-CRP, and PCT levels before and after surgery were lower in the observation group than that in the control group, with statistically significant differences (P < 0.05). At 6 hours postoperatively, the VAS score in the observation group was lower than that in the control group (P < 0.05), but no statistically significant differences were observed at 12 hours and 24 hours postoperatively. The total incidence of postoperative complications in the observation group was lower than that in the control group (P < 0.05). Conclusion Percutaneous nephrolithotomy combined with flexible ureteroscopic holmium laser lithotripsy for the treatment of complex renal calculi can improve the primary stone clearance rate, reduce postoperative complications, and is safe and effective. -
Key words:
- Renal calculi /
- Ureteroscopes /
- Percutaneous nephrolithotripsy
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表 1 2组复杂性肾结石患者基线资料比较
Table 1. Comparison of baseline characteristics in patients with complex kidney stones
组别 例数 性别(例) 年龄(x±s，岁) 侧别(例) 结石体积(x±s，cm3) 结石类型(例) 男性 女性 左侧 右侧 鹿角形结石 多发性结石 观察组 26 14 12 54.12±10.07 11 15 4.31±0.73 9 17 对照组 27 15 12 53.00±13.24 15 12 4.54±0.55 8 19 统计量 0.016a 0.379b 0.925a 1.596b 0.151a P值 0.899 0.705 0.336 0.115 0.698 注：a为χ2值，b为t值。 
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表 2 2组复杂性肾结石患者住院及手术相关资料比较
Table 2. Comparison of hospitalization and surgical-related data between the two groups of patients with complex kidney stones
组别 例数 手术时间(x±s，min) 住院时间(x±s，d) 住院费用(x±s，万元) 一次性结石清除[例(%)] 通道个数(x±s，个) 观察组 26 128.54±20.73 9.04±2.52 1.78±0.19 22(84.62) 1.27±0.45 对照组 27 160.81±28.24 11.04±2.88 2.02±0.31 15(55.56) 2.37±0.69 统计量 4.728a 2.686a 3.567a 4.018b 6.911a P值 ＜0.001 0.010 ＜0.001 0.035 ＜0.001 注：a为t值，b为χ2值。
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表 3 2组复杂性肾结石患者手术前后肾功能指标比较[M(P25，P75)]
Table 3. Comparison of renal function parameters before and after surgery between the two groups of patients with complex kidney stones [M(P25, P75)].
组别 例数 Cr(μmol/L) 术前 术后 手术前后差值 观察组 26 78.50(68.75, 93.25) 85.50(75.75, 103.00)a 7.50(4.00, 10.75) 对照组 27 73.00(63.00, 104.00) 114.00(89.00, 144.00)a 23.00(18.00, 30.00) Z值 0.154 3.484 6.405 P值 0.877 ＜0.001 ＜0.001 组别 例数 BUN(mmol/L) 术前 术后 手术前后差值 多镜联合组 26 6.40(5.30, 7.55) 6.90(6.00, 8.13)a 0.40(0.30, 0.50) PCNL组 27 6.30(5.70, 7.70) 8.30(7.40, 10.10)a 1.60(1.40, 2.60) Z值 0.627 4.391 7.032 P值 0.530 ＜0.001 ＜0.001 组别 例数 β2-MG(mg/L) 术前 术后 手术前后差值 观察组 26 2.77(2.39, 3.42) 2.81(2.47, 3.48)a 0.06(0.04, 0.07) 对照组 27 2.98(2.49, 3.52) 3.54(2.93, 3.89)a 0.47(0.30, 0.64) Z值 0.668 3.350 7.216 P值 0.504 ＜0.001 ＜0.001 注：与同组术前比较，aP＜0.05。
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表 4 2组复杂性肾结石患者手术前后Hb、hs-CRP、PCT比较(x±s)
Table 4. Comparison of Hb, hs-CRP, and PCT levels before and after surgery between the two groups of patients with complex kidney stones (x±s)
组别 例数 Hb(g/L) Hb下降值 术前 术后 观察组 26 145.64±2.92 132.79±5.47b 12.85±4.08 对照组 27 144.52±2.55 128.37±5.54b 16.15±5.03 统计量 1.753a 7.776c 3.139a P值 0.083 0.007 0.003 组别 例数 hs-CRP(mg/L) 手术前后差值 术前 术后 观察组 26 1.49±0.78 1.81±0.80b 0.32±0.10 对照组 27 1.37±0.82 1.81±0.84b 0.45±0.13 统计量 0.673a 19.937c 4.828a P值 0.503 ＜0.001 ＜0.001 组别 例数 PCT(mg/L) 手术前后差值 术前 术后 观察组 26 0.10±0.01 0.25±0.08b 0.15±0.08 对照组 27 0.11±0.01 0.30±0.06b 0.19±0.05 统计量 1.671a 7.140c 2.730a P值 0.099 0.009 0.010 注：a为t值，c为F值；与同组术前比较，bP＜0.05。
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表 5 2组复杂性肾结石患者术后6、12、24 h VAS评分比较[M(P25, P75), 分]
Table 5. Comparison of postoperative VAS (6, 12, 24h) between the two groups of patients with complex kidney stones [M(P25, P75), points]
组别 例数 6 h 12 h 24 h 观察组 26 2.00(1.00, 2.00) 1.00(0.00, 1.00)a 0.00(0.00, 0.00)ab 对照组 27 2.00(2.00, 3.00) 1.00(1.00, 1.00)a 0.00(0.00, 0.00)ab Z值 3.314 1.576 1.153 P值 ＜0.001 0.115 0.249 注：与同组术后6 h比较，aP＜0.05；与同组术后12 h比较，bP＜0.05。
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表 6 2组复杂性肾结石患者VAS评分比较的广义估计方程分析
Table 6. Generalized estimating equation analysis of VAS score comparison between two groups of patients with complex kidney stones
组别 时间 B SE Waldχ2 P值 OR值 95% CI 观察组 术后6 h 1.692 0.142 143.000 ＜0.001 5.432 4.116~7.168 术后12 h 0.615 0.095 41.600 ＜0.001 1.850 1.535~2.231 对照组 术后6 h 2.222 0.109 415.385 ＜0.001 9.228 7.452~11.426 术后12 h 0.778 0.080 94.500 ＜0.001 2.177 1.861~2.546 组间 术后6 h -0.530 0.179 8.798 0.003 0.589 0.415~0.835 术后12 h -0.162 0.125 1.701 0.192 0.850 0.666~1.085 注：均以术后24 h为参照。
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表 7 2组复杂性肾结石患者术后并发症发生率比较
Table 7. Comparison of postoperative complication rates between the two groups of patients with complex kidney stones
组别 例数 发热(例) 肾脏出血(例) 尿瘘(例) 总发生[例(%)] 观察组 26 1 1 0 2(7.69) 对照组 27 4 5 0 9(33.33) χ2值 0.802 1.567 5.295 P值 0.370 0.211 0.021
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