Abstract：objective： To observe the clinical effectiveness of modular flexible ureteroscope combined with minimally invasive percutaneous nephroscopy (MPCNL) for patients with residual renal calculi, and to evaluate its effect on inflammatory reaction and renal function. Methods： A retrospective analysis on 179 patients with residual renal stones with diameters in 0.8-2.5 cm were included, and the patients were randomly divided into two groups according to different surgical methods. The double mirror group was treated with modular flexible ureteroscope combined with MPCNL (87 cases). The nephroscope group was treated with MPCNL (92 cases). Comparisons between the two groups were made with respect to duration of operative time, intraoperative blood loss, postoperative hospital stay, stone clearance rate and complication rate. The changes in blood indicators [white blood cell (WBC) count, C-reactive protein (CRP), procalcitonin (PCT), blood urea nitrogen (BUN), creatinine (Cr) and beta2-microglobulin (β2-MG)] were detected in two groups. Results： The mean operative time, intraoperative blood loss, postoperative hospital stay, stone clearance rate, complication rate and total cost were (37.1±15.5) min, (11.8±6.7) mL, (3.2±1.2) days, 96.6%, 4.6%, (2.4±0.9) ten thousand RMB yuan in double mirror group, and (48.3±21.4) min, (39.6±22.5) mL, (4.8±1.6) days, 93.5%, 10.7%, (1.8±0.7) ten thousand RMB yuan in the nephroscope group. There was significant difference in the operative time, intraoperative blood loss, complication rate and total cost between two groups (P<0.05). After surgery, the levels of CRP, PCT and β2-MG in nephroscope group were significantly higher than those in double mirror group (P<0.05). There were no significant differences between the two groups in WBC count, and levels of BUN and Cr (P>0.05). Conclusion： Modular flexible ureteroscope combined with MPCNL is effective and safe in the treatment of residual renal calculi, and it demonstrates higher stone clearance rate, less trauma, less blood loss, shorter hospital stay, lower complications rate, milder inflammatory reaction and has milder damage to the renal function, which is worthy of popularization and application.
[1] 王锐,石洪波,周吉,等.单通道经皮肾镜后二期联合逆行输尿管软镜治疗复杂性肾结石疗效分析.微创泌尿外科杂志,2018,7(2):101-104.
[2] 王亚园,许长宝,褚校涵,等.超微经皮肾镜与输尿管软镜治疗直径2-3cm高CT值肾结石疗效对比.实用医学杂志,2018,34(13):2181-2184.
[3] SOROKIN I, MAMOULAKIS C, MIYAZAWA K, et al.Epidemiology of stone disease across the world. World J Urol, 2017,35(9):1301-1320.
[4] 张道新,王文营,李钧,等.基于可视化穿刺的极微通道经皮肾镜术治疗肾结石的现状和进展.国际外科学杂志,2017,44(9):127-130.
[5] SHAH AK, XU KW, LIU H, et al.Implementation of ultramini percutaneous nephrolithotomy for treatment of 2-3 cm kidney stones: a preliminary report. J Endourol, 2015,29(11):1231-1236.
[6] 樊胜海,周立权,黎承杨,等.经皮肾镜取石术中术后出血的风险因素分析.临床泌尿外科杂志,2015,30(12):1100-1104.
[7] 张遂兵,潘卫兵,金岩.输尿管软镜联合经皮肾镜术治疗与经皮肾镜通道平行的术后残石.广东医学,2018,39(Suppl):209-212.
[8] 汪彬,许景东,项华.经皮肾镜联合输尿管软镜治疗对复杂性肾结石BMG,BUA的影响及临床疗效分析.国际泌尿系统杂志,2019,39(1):60-63.
[9] 程跃,谢国海,严泽军,等.逆行输尿管软镜联合可视微通道经皮肾镜一期治疗鹿角形肾结石的临床分析.中华泌尿外科杂志,2016,37(2):127-130.
[10] LENG SB, XIE DH, ZHONG Y, et al.Combined single-tract of minimally percutaneous nephrolithotomy and flexible ureteroscopy for staghorn calculi in oblique supine lithotomy position. Surg Innov, 2018,25(1):22-27.
[11] 李天,朱柏珍,李逊,等.留置输尿管支架管合并发热性尿路感染男性患者的临床特征研究.中华医院感染学杂志,2018,28(1):92-95.
[12] AOKI Y, TANIAI N, YOSHIOKA M, et al.Serum procalcitonin concentration within 2 days postoperatively accurately predicts outcome after liver resection. Clin Chem Lab Med, 2018,56(8):1362-1372.
[13] 杨成林,王尉,周五二,等.改良无萎缩性三步法肾实质切开取石术治疗复杂性鹿角形肾结石效果分析.中华外科杂志,2017,55(10):746-750.
