二期局麻下应用膀胱软镜处理复杂性肾结石经皮肾镜术后残石的研究

doi:10.3877/cma.j.issn.1674-3253.2024.01.013

目的

探讨二期局部麻醉下应用膀胱软镜处理复杂性肾结石微创经皮肾镜术后残石的临床疗效，评估其安全性和可行性。

方法

回顾性分析曲靖市第一人民医院2019年1月至2021年12月收治的二期手术治疗复杂性肾结石一期微创经皮肾镜术后残石患者的临床资料，按照手术方式的不同分为观察组（应用膀胱软镜组）56例和对照组（应用经皮肾硬镜组）38例，两组在年龄、性别、残留结石最大直径、位置以及数目等一般资料上比较差异无统计学意义（P>0.05）。比较两组在残石清除率、手术时间、术后24 h Hb下降量、术后24 h患者疼痛评分（VAS）、术后造瘘管留置根数、住院时间以及并发症发生情况方面的差异。

结果

在结石清除率方面：观察组为92.9%（52/56），对照组为94.7%（36/38），差异无统计学意义（P>0.05）；在手术时间、术后24 h Hb下降量、术后24 h患者疼痛评分（VAS）、术后造瘘管留置根数及住院时间方面观察组均优于对照组，差异有统计学意义（P<0.05）；在并发症发生情况方面：两组均无严重并发症发生，观察组并发症发生率为8.9%（5/56），对照组为23.7%（9/38），差异有统计学意义（P<0.05）。

结论

二期局麻下应用膀胱软镜处理复杂性肾结石微创经皮肾镜术后残石的方法安全且高效。

关键词: 复杂性肾结石, 经皮肾镜碎石取石术, 局部麻醉, 膀胱软镜

Objective

To investigate the clinical efficacy of using flexible cystoscope under secondary local anesthesia in the treatment of residual stone after minimally invasive percutaneous nephroscopy for complex kidney stones, and to evaluate its safety and feasibility.

Methods

Through retrospective analysis of the clinical data of patients with residual stones after one-stage minimally invasive percutaneous nephrolithotomy treated with complex renal stones in the First People’s Hospital of Qujing from January 2019 to December 2021, 56 patients were divided into observation group (the flexible cystoscope group) and control group (the percutaneous nephroscopy group) according to different surgical methods.There was no significant difference in age, sex, maximum diameter, location and number of residual stones between the two groups (P>0.05). The differences in residual stone removal rate, operative time, postoperative 24 h Hb decline, postoperative pain score (VAS), number of indent roots of postoperative fistula, length of hospital stay and incidence of complications were compared between the two groups.

Results

The calculi clearance rate was 92.9%(52/56) in the observation group and 94.7% (36/38) in the control group, with no significant difference (P>0.05). The observation group was superior to the control group in terms of operation time, postoperative 24 h Hb decline, postoperative pain score (VAS), postoperative catheter indentation number and hospital stay, with significant differences (P<0.05). In terms of the occurrence of complications: no serious complications occurred in the two groups, the incidence of complications was 8.9%(5/56) in the observation group and 23.7%(9/38) in the control group, with significant difference (P<0.05).

Conclusions

It is safe and effective to treat residual stone after minimally invasive percutaneous nephroscopy with bladder flexible cystoscope under local anesthesia.

Key words: Complex kidney stones, Percutaneous nephrolithotomy, Local anesthesia, Flexible cystoscope

表1 两组复杂性肾结石PCNL术后残石行二期手术患者术前临床资料对比

组别	例数	性别(例)		年龄[岁，(±s)]	残石直径[mm，(±s)]	残石位置(例)		残石数目(例)
组别	例数	男	女	年龄[岁，(±s)]	残石直径[mm，(±s)]	左侧	右侧	单发	多发
观察组	56	31	25	48±14	13±3	30	26	8	48
对照组	38	20	18	50±13	13±4	21	17	7	31
统计值		χ²=0.068		t=-0.665	t=-0.722	χ²=0.026		χ²=0.289
P值		0.795		0.508	0.472	0.872		0.591

表1 两组复杂性肾结石PCNL术后残石行二期手术患者术前临床资料对比

组别	例数	性别(例)		年龄[岁，(±s)]	残石直径[mm，(±s)]	残石位置(例)		残石数目(例)
组别	例数	男	女	年龄[岁，(±s)]	残石直径[mm，(±s)]	左侧	右侧	单发	多发
观察组	56	31	25	48±14	13±3	30	26	8	48
对照组	38	20	18	50±13	13±4	21	17	7	31
统计值		χ²=0.068		t=-0.665	t=-0.722	χ²=0.026		χ²=0.289
P值		0.795		0.508	0.472	0.872		0.591

表2 两组复杂性肾结石PCNL术后残石行二期手术患者手术相关资料对比

组别	例数	残石清除率(%)	手术时间[min，(±s)]	术后24 h Hb下降量[g/L，M(Q₁，Q₃)]	术后疼痛评分[VAS，(±s)]	肾造瘘管留置数（例）			住院时间[d，(±s)]
组别	例数	残石清除率(%)	手术时间[min，(±s)]	术后24 h Hb下降量[g/L，M(Q₁，Q₃)]	术后疼痛评分[VAS，(±s)]	0根	1根	2根	住院时间[d，(±s)]
观察组	56	92.9%	43±14	6.8(3.0，10.0)	2.7±1.4	16	40	0	2.7±1.4
对照组	38	94.7%	53±13	8.0(3.8，12.4)	5.1±1.5	0	37	1	4.9±1.3
统计值		χ²=0.134	t=-3.124	Z=-3.721	t=-7.880	χ²=14.190			t=-7.840
P值		0.714	0.002	<0.001	<0.001	<0.001			<0.001

表2 两组复杂性肾结石PCNL术后残石行二期手术患者手术相关资料对比

组别	例数	残石清除率(%)	手术时间[min，(±s)]	术后24 h Hb下降量[g/L，M(Q₁，Q₃)]	术后疼痛评分[VAS，(±s)]	肾造瘘管留置数（例）			住院时间[d，(±s)]
组别	例数	残石清除率(%)	手术时间[min，(±s)]	术后24 h Hb下降量[g/L，M(Q₁，Q₃)]	术后疼痛评分[VAS，(±s)]	0根	1根	2根	住院时间[d，(±s)]
观察组	56	92.9%	43±14	6.8(3.0，10.0)	2.7±1.4	16	40	0	2.7±1.4
对照组	38	94.7%	53±13	8.0(3.8，12.4)	5.1±1.5	0	37	1	4.9±1.3
统计值		χ²=0.134	t=-3.124	Z=-3.721	t=-7.880	χ²=14.190			t=-7.840
P值		0.714	0.002	<0.001	<0.001	<0.001			<0.001

表3 两组复杂性肾结石PCNL术后残石行二期手术患者并发症发生情况对比

组别	例数	发热例数	出血例数	发生率（%）
观察组	56	5	0	8.9
对照组	38	7	2	23.7
χ²值				3.889
P值				0.049

表3 两组复杂性肾结石PCNL术后残石行二期手术患者并发症发生情况对比

组别	例数	发热例数	出血例数	发生率（%）
观察组	56	5	0	8.9
对照组	38	7	2	23.7
χ²值				3.889
P值				0.049

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Study on the application of bladder flexible cystoscopy in the treatment of residual stones after percutaneous nephrolithotomy for complex renal calculi under local anesthesia

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Study on the application of bladder flexible cystoscopy in the treatment of residual stones after percutaneous nephrolithotomy for complex renal calculi under local anesthesia