摘要
目的比较输尿管软镜碎石术(RIRS)与微通道经皮肾镜取石术(mini-PCNL)在<2.0 cm肾下盏结石患者中的应用效果。方法将2022年10月至2023年4月新乡医学院第一附属医院泌尿外科二病区收治的116例肾下盏结石(<2.0 cm)患者纳入研究,按随机数表法分为RIRS组和mini-PCNL组,每组58例。RIRS组患者采取RIRS治疗,mini-PCNL组患者采取mini-PCNL治疗,比较两组患者的手术相关情况和术后6 h、12 h、24 h的疼痛(VAS)评分、舒适度(BCS)评分,术前及术后6 h、12 h、24 h的应激反应[肾上腺素(E)、去甲肾上腺素(NE)、皮质醇(Cor)]、急性肾损伤血清双功能氧化酶1(DUOX1)、NADPH氧化酶亚基(NOX)2、NOX4蛋白表达变化,同时比较两组患者的并发症及随访6个月时的结石复发情况。结果RIRS组患者的手术时间为(51.26±6.32)min,长于mini-PCNL组的(43.65±5.47)min,术后血红蛋白下降值、术后住院时间分别为(2.53±0.56)g/L、(3.08±0.62)d,明显少于mini-PCNL组的(6.75±1.19)g/L、(4.76±0.78)d,差异均有统计学意义(P<0.05);术后6 h、12 h、24 h,RIRS组患者的VAS评分分别为(3.91±0.76)分、(2.41±0.47)分、(0.91±0.23)分,明显低于mini-PCNL组的(5.78±1.02)分、(4.13±0.69)分、(1.66±0.35)分,BCS评分分别为(2.58±0.60)分、(3.03±0.51)分、(3.67±0.22)分,明显高于mini-PCNL组的(1.42±0.42)分、(2.16±0.48)分、(3.05±0.31)分,差异均有统计学意义(P<0.05);术后6 h、12 h、24 h,RIRS组患者的NE分别为(334.48±26.53)μg/L、(302.36±20.14)μg/L、(267.52±24.10)μg/L,明显低于mini-PCNL组的(362.23±30.47)μg/L、(346.32±18.65)μg/L、(342.63±28.28)μg/L,E分别为(0.31±0.08)μg/L、(0.26±0.10)μg/L、(0.20±0.09)μg/L,明显低于mini-PCNL组的(0.45±0.10)μg/L、(0.34±0.12)μg/L、(0.29±0.08)μg/L,Cor分别为(238.24±24.57)ng/mL、(220.36±21.02)ng/mL、(204.75±19.36)ng/mL,明显低于mini-PCNL组的(286.23±28.17)ng/mL、(268.65±23.69)ng/mL、(247.42±25.37)ng/mL,差异均有统计学意义(P<0.05);术后6 h
Objective To compare the efficacy of retrograde intrarenal surgery(RIRS)and minimally invasive percutaneous nephrolithotomy(mini-PCNL)in patients with renal lower calyceal stones<2.0 cm.Methods A total of 116 patients with lower pole renal calculi(<2.0 cm)admitted to WardⅡ,Department of Urology,the First Affiliated Hospital of Xinxiang Medical University from October 2022 to April 2023 were included in the study.They were randomly divided into the RIRS group and the mini-PCNL group according to a random number table,with 58 patients in each group.Patients in the RIRS group were treated with RIRS,while patients in the mini-PCNL group were treated with mini-PCNL.The surgical-related conditions of the two groups were compared,as well as pain(Visual Analogue Scale,VAS)scores and comfort(Bruggrmann Comfort Scale,BCS)scores of the two groups at 6 hours,12 hours,and 24 hours after surgery,the stress response[adrenaline(E),norepinephrine(NE),cortisol(Cor)]of the two groups before and at 6 hours,12 hours,and 24 hours after surgery,the changes in serum dual oxidase 1(DUOX1),NADPH oxidase subunit(NOX)2,and NOX4 protein in acute renal injury.The complications and stone recurrence at 6 months of follow-up were also compared between the two groups.Results The operation time in the RIRS group was(51.26±6.32)min,which was longer than(43.65±5.47)min in the mini-PCNL group;the postoperative hemoglobin decrease and postoperative length of hospital stay were(2.53±0.56)g/L and(3.08±0.62)d,respectively,which were less/shorter than(6.75±1.19)g/L and(4.76±0.78)d in the mini-PCNL group;the differences were statistically significant(P<0.05).The VAS scores of patients in the RIRS group were(3.91±0.76)points,(2.41±0.47)points,and(0.91±0.23)points,respectively,which were significantly lower than(5.78±1.02)points,(4.13±0.69)points,and(1.66±0.35)points in the mini-PCNL group(P<0.05).The BCS scores were(2.58±0.60)points,(3.03±0.51)points,and(3.67±0.22)points,respectively,which were significantly higher than(1.42±0.42)points,(2
作者
李泽宇
马阔
张冠英
刘沛
何岩
韩广业
LI Ze-yu;MA Kuo;ZHANG Guan-ying;LIU Pei;HE Yan;HAN Guang-ye(WardⅡ,Department of Urology,the First Affiliated Hospital of Xinxiang Medical University,Xinxiang 453100,Henan,CHINA)
出处
《海南医学》
CAS
2024年第9期1265-1270,共6页
Hainan Medical Journal
基金
河南省医学科技攻关计划项目(编号:LHGJ20220607)。
关键词
肾下盏结石
输尿管软镜碎石术
微通道经皮肾镜取石术
疼痛程度
舒适度
急性肾损伤
应激反应
复发
Subrenal calyx calculus
Flexible ureteral lithotripsy
Mini-percutaneous nephrolithotomy
Degree of pain
Comfort level
Acute kidney injury
Stress response
Recurrence
