Abstract:

Objective　To explore the the clinical effect of lithotripsy assisted by a physical vibration stone removal machine in the treatment of elderly patients with complex renal calculi. Methods　One hundred and twenty elderly patients with complex renal calculi treated at Baoji People's Hospital from January 2021 to January 2024 were selected for the randomized controlled trial, and were divided into a control group and a study group by the random number table method, with 60 cases in each group. There were 38 males and 22 females in the control group; they were (71.8±4.8) years old. There were 35 males and 25 females in the study group; they were (72.3±4.5) years old. The control group underwent conventional lithotripsy; in addition, the study group were treated by the physical vibration stone expulsion machine. The one-time stone clearance rates, operation times, lithotripsy times, times for off-bed activity, hospitalization times, and bleeding volumes during the operation, levels of oxidative stress markers [malonaldehyde (MDA), cortisol (Cor), and superoxide dismutase (SOD)] and inflammatory cytokines [C-reaction protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor α (TNF-α)], and the incidence rates of complications were compared between the two groups by t and χ² tests. Results　There was no statistical difference in the one-time stone clearance rate between the study group and the control group [100.0% (60/60) vs. 96.7% (58/60); χ²=2.033; P=0.153]. There was no statistical difference in the operation time between the two groups (P>0.05). The lithotripsy time, time for off-bed activity, hospitalization time, and bleeding volume during the operation in the study group were lower than those in the control group [(80.12±10.05) min vs. (85.33±11.02) min, (31.51±4.02) h vs. (42.26±6.11) h, (5.41±0.24) d vs. (6.95±0.36) d, and (82.44±11.14) ml vs. (101.34±20.33) ml], with statistical differences (t=2.705, 11.385, 27.570, and 6.315; all P<0.05). There were no statistical differences in the the levels of oxidative stress markers and inflammatory cytokines between the two groups before the treatment. After the treatment, the levels of MDA, Cor, CRP, IL-6, TNF-α, and SOD in the study group were better than those in the control group [(7.90±1.25) nmol/L vs. (10.11±1.03) nmol/L, (241.20±10.34) μg/L vs. (280.84±12.25) μg/L, (18.52±2.17) mg/L vs. (25.03±3.14) mg/L, (5.41±0.14) ng/L vs. (8.01±0.13) ng/L, (60.46±5.12) nmol/ml vs. (81.03±6.31) nmol/ml, and (68.82±6.61) NU/ml vs. (63.26±6.55) NU/ml], with statistical differences (t=10.569, 19.154, 13.211, 105.415, 4.186, and 4.628; all P<0.05). There was no statistical difference in the incidence rate of postoperative complications between the control group and the study group [6.67%(4/60) vs. 3.33%(2/60); P>0.05]. Conclusion　Lithotripsy assisted by a physical vibration stone removal machine in the treatment of elderly patients with complex renal calculi can improve the operation efficacy and the success rate of stone removal, shorten the operation time, and decrease the risk of complications.

Key words:

Renal calculi, Complex, The elderly, Physical vibration stone removal machine, Lithotripsy, Clinical effect

摘要：

目的　探讨物理振动排石机辅助碎石取石术治疗老年复杂性肾结石的临床效果。方法　选取2021年1月至2024年1月宝鸡市人民医院收治的120例老年复杂性肾结石患者进行随机对照试验，采用随机数字表法分为对照组（60例）和研究组（60例）。对照组男38例、女22例，年龄（71.8±4.8）岁，采用常规碎石取石术治疗；研究组男35例、女25例，年龄（72.3±4.5）岁，在对照组基础上辅以物理振动排石机治疗。对比两组患者一次性结石清除率、手术相关指标（手术时间、碎石时间、下床活动时间、住院时间和术中出血量）、氧化应激指标［丙二醛（MDA）、皮质醇（Cor）、氧化物歧化酶（SOD）］、炎症因子水平［C反应蛋白（CRP）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）］及并发症发生情况。统计学方法采用t检验、χ²检验。结果　研究组结石清除率为100.0%（60/60），与对照组的96.7%（58/60）比较，差异无统计学意义（χ²=2.033，P=0.153）。两组患者手术时间比较，差异无统计学意义（P>0.05）。研究组碎石时间、下床活动时间、住院时间均短于对照组［（80.12±10.05）min比（85.33±11.02）min、（31.51±4.02）h比（42.26±6.11）h、（5.41±0.24）d比（6.95±0.36）d］，术中出血量低于对照组［（82.44±11.14）ml比（101.34±20.33）ml］，差异均有统计学意义（t=2.705、11.385、27.570、6.315，均P<0.05）。治疗前，两组患者氧化应激指标及炎症因子水平比较，差异均无统计学意义（均P>0.05）。治疗后，研究组MDA、Cor及CRP、IL-6、TNF-α水平均低于对照组［（7.90±1.25）nmol/L比（10.11±1.03）nmol/L、（241.20±10.34）μg/L比（280.84±12.25）μg/L、（18.52±2.17）mg/L比（25.03±3.14）mg/L、（5.41±0.14）ng/L比（8.01±0.13）ng/L、（60.46±5.12）nmol/ml比（81.03±6.31）nmol/ml］，SOD指标高于对照组［（68.82±6.61）NU/ml比（63.26±6.55）NU/ml］，差异均有统计学意义（t=10.569、19.154、13.211、105.415、4.186、4.628，均P<0.05）。对照组术后并发症发生率为6.67%（4/60），与研究组［3.33%（2/60）］比较，差异无统计学意义（P>0.05）。结论　物理振动排石机辅助碎石取石术治疗老年复杂性肾结石患者，可有效提高手术效率和取石成功率，缩短手术时间，并降低并发症风险。

关键词:

肾结石, 复杂性, 老年, 物理振动排石机, 碎石取石术, 临床效果