Effect of percutaneous nephrolithotripsy under micro channel and standard channel on stone removal and complications in elderly patients with renal calculi
LI Jiantao1, TANG Xiaoxu1, ZHANG Lidong1, XIE Jiaen1, ZHAO Jun1, WANG Mingchuan1, CHEN Shunqi1
1Department of Urology, Chongqing Kaizhou District People's Hospital, Kaizhou District, Chongqing 405199, China
Abstract:Objective: To discuss the effect of percutaneous nephrolithotripsy (PCNL) under micro channel and standard channel on the stone removal and complications in elderly patients with renal calculi. Methods: A total of 120 elderly patients with renal calculi in our hospital from July 2017 to July 2019 were selected, and equally divided into micro channel group and standard channel group according to the random number table. The micro channel group was treated with PCNL via a micro channel, and the standard channel group was treated with PCNL via a standard channel. the stone removal effect, perioperative indexes, renal function [blood urea nitrogen (BUN) and serum creatinine (SCR)], inflammatory stress [C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6)], and complications were compared between the two groups. Results: There was no significant difference in stone clearance rate between the micro channel group and the standard channel group (P > 0.05). The operation time in the micro channel group was significantly longer than that in the standard channel group, the bleeding volume, time out of bed and time of hospitalization in the micro channel group were significantly reduced as compared with those in the standard channel group with the difference being statistically significant (P < 0.05). The BUN, SCR, CRP, TNF-alpha and IL-6 in the micro channel group were significantly lower than those in the standard channel group with the difference being statistically significant (P < 0.05). The incidence of complications in micro channel group was significantly lower than that in standard channel group (P < 0.05). Conclusions: Compare with the standard channel, PCNL via the micro channel has the good stone removal effect in elderly patients with renal calculi, and it can effectively reduce the renal function damage and inflammatory stress response of patients, which is helpful to reduce the postoperative complications, and worth for further clinical promotion.
李建涛, 唐晓旭, 张立冬, 谢家恩, 赵军, 王明川, 陈舜琦. 微通道与标准通道下经皮肾镜碎石术对老年肾结石患者排石效果及并发症的影响[J]. 微创泌尿外科杂志, 2020, 9(6): 371-375.
LI Jiantao, TANG Xiaoxu, ZHANG Lidong, XIE Jiaen, ZHAO Jun, WANG Mingchuan, CHEN Shunqi. Effect of percutaneous nephrolithotripsy under micro channel and standard channel on stone removal and complications in elderly patients with renal calculi. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(6): 371-375.
[1] 王兴源,麻立,贾光,等.中老年肾结石患者侧卧位在经皮肾镜手术中的应用效果.中国老年学杂志,2018,38(10):2394-2396. [2] GIUSTI G, LISA A.Massive migration of embolization coils inside the renal pelvis. A rare complication that can be approached through percutaneous surgery. Cent European J Urol, 2018,71(4):467-469. [3] 鲁仕伟,钱云程,姚跃.微通道与标准通道经皮肾镜碎石术对肾结石患者术后应激反应的影响.国际泌尿系统杂志,2018,38(5):712-715. [4] ZHU M, WANG XY, SHI ZQ, et al.Comparison between retrograde intrarenal surgery and percutaneous nephrolithotripsy in the management of renal stones: A meta-analysis. Exp Ther Med, 2019,18(2):1366-1374. [5] 《泌尿外科杂志(电子版)》编辑部.泌尿系结石诊治指南解读(二):肾结石治疗.泌尿外科杂志(电子版),2012,4(1):46-48. [6] 向宸辉,刘小勇,王鹏桥,等.PCNL治疗ESWL失败的老年肾结石患者的有效性及安全性.西南国防医药,2017,27(5):456-459. [7] 鲁成军,董自强,田金波,等.两种无管化经皮肾镜取石术对≤3 cm肾结石患者清石效果及生活质量的影响.微创泌尿外科杂志,2019,8(2):84-87. [8] GULTEKIN MH, TUREGUN FA, OZKAN BA, et al.Does previous open renal stone surgery affect the outcome of extracorporeal shockwave lithotripsy treatment in adults with renal stones? J Endourol, 2017,31(12):1295-1300. [9] 洪涛,柯莽,俞洪元,等.不同口径通道对经皮肾镜取石手术患者术后感染的影响.中华医院感染学杂志,2017,27(7):1568-1571. [10] 闫河峰,王天喜,刘涛,等.微通道经皮肾镜取石术与标准通道经皮肾镜取石术治疗肾结石疗效及对患者肾指标的影响.中国医学工程,2017,25(12):26-29. [11] FELICI EM, DINIZ ALL, SOUZA TA, et al.Can renal stone size and the use of the nephrolithometric system increase the efficacy of predicting the risk of failure of percutaneous nephrolithotripsy? Rev Col Bras Cir, 2017,44(6):619-625. [12] 符仕宝,肖劲逐,何书明,等.标准通道与微通道在PCNL中的应用效果及对患者术后感染的影响.西部医学,2018,30(12):1817-1820. [13] ALCALDE ÁF, HERNÁNDEZ MR, SANTOS VD, et al. Comparison between percutaneous nephrolithotomy and flexible ureteroscopy for the treatment of 2 and 3 cm renal lithiasis. Actas Urol Esp, 2019,43(3):111-117. [14] 张刚. 标准通道与微通道经皮肾镜取石术对肾结石患者结石清除率和血清炎性因子影响的对比研究.解放军预防医学杂志,2018,36(1):87-90. [15] ZHU C, LIANG Q, LIU YQ, et al.Kidney injury in response to crystallization of Calcium oxalate leads to rearrangement of the intrarenal T cell receptor delta immune repertoire. J Transl Med, 2019,17(1):278.