Abstract:

Objective　To observe the influence of flexible ureteroscopic lithotripsy on renal function, pain stress indicators, and recurrence rate in male patients with renal calculi. Methods　A total of 92 male patients with chronic renal calculi with diameter <2.5 cm admitted to the 989th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China from June 2018 to June 2023 were included and were divided into an observation group and a control group by simple randomization method, with 46 cases in each group, which were treated by flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy, respectively. The observation group was (42.39±6.12) years old, and the maximum diameter of the stones was (1.94±0.22) cm. The control group was (41.87±5.96) years old, and the maximum diameter of the stones was (1.88±0.50) cm. The perioperative parameters (operation time, intraoperative blood loss, postoperative hospital stay, and stone clearance rate), renal function indexes [cystatin C (Cys-C) and serum creatinine (Scr)] and pain stress indexes [cortisol (Cor) and endothelin-1 (ET-1)] before surgery and 3 d after surgery, postoperative complications, and stone recurrence rate within 6 months after surgery were compared between the two groups. χ² test, Fisher exact probability method, and t test were used. Results　The operation time of the observation group was (86.45±11.27) min, which was longer than that of the control group [(47.29±6.31) min]; the intraoperative blood loss was (9.01±2.32) ml, which was lower than that of the control group [(24.72±6.69) ml]; the postoperative hospital stay was (4.62±0.86) d, which was shorter than that of the control group [(5.57±0.99) d], with statistically significant differences (t=20.563, 14.048, and 4.913, all P<0.001). The serum levels of Cys-C, Scr, Cor, and ET-1 in the observation group 3 d after surgery were (2.29±0.60) mg/L, (90.33±6.09) μmol/L, (150.67±25.38) mg/L, and (113.70±21.09) ng/L, respectively, which were lower than those in the control group [(2.77±0.72) mg/L, (95.71±6.38) μmol/L, (188.76±29.80) mg/L, and (132.84±26.72) ng/L], with statistically significant differences (t=3.474, 4.137, 6.600, and 3.814, all P<0.001). The total incidence of postoperative complications in the observation group was 2.17% (1/46), which was lower than that in the control group [15.22% (7/46)], with a statistically significant difference (χ²=4.913, P=0.026). The recurrence rate was 2.63% (1/46) in the observation group and no recurrence in the control group within 6 months after surgery, without statistically significant difference in the recurrence rate between the two groups (P=1.000). Conclusion　There is no significant difference in the stone clearance rate or recurrence rate in flexible ureteroscopic lithotripsy compared to percutaneous nephrolithotomy in the treatment of male renal calculi with diameter <2.5 cm, but the intraoperative blood loss, postoperative hospital stay, and incidence of complications are lower, and the postoperative renal function and pain stress indicators recover faster.

Key words:

Renal calculi, Male, Flexible ureteroscopic lithotripsy, Percutaneous nephrolithotomy, Renal function, Pain stress, Recurrence

摘要：

目的　观察输尿管软镜碎石取石术对男性肾结石患者肾功能、疼痛应激指标及复发率的影响。方法　纳入2018年6月至2023年6月期间中国人民解放军联勤保障部队第九八九医院收治的92例慢性男性肾结石（最大径<2.5 cm）患者，采用简单随机化法分为观察组、对照组各46例，分别采用输尿管软镜碎石取石术、经皮肾镜碎石取石术治疗。观察组年龄（42.39±6.12）岁，结石最大径（1.94±0.22）cm；对照组年龄（41.87±5.96）岁，结石最大径（1.88±0.50）cm。比较两组患者围手术期指标（手术时间、术中出血量、术后住院时间、结石清除率），术前及术后3 d肾功能指标［胱抑素C（Cys-C）、血肌酐（Scr）］、疼痛应激指标［皮质醇（Cor）、内皮素-1（ET-1）］，术后并发症及术后6个月结石复发率。采用χ²检验、Fisher确切概率法、t检验。结果　观察组手术时间为（86.45±11.27）min，长于对照组的（47.29±6.31）min，差异有统计学意义（t=20.563，P<0.001）；术中出血量为（9.01±2.32）ml，少于对照组的（24.72±6.69）ml，差异有统计学意义（t=14.048，P<0.001）；术后住院时间为（4.62±0.86）d，短于对照组的（5.57±0.99）d，差异有统计学意义（t=4.913，P<0.001）。观察组术后3 d血清Cys-C、Scr、Cor、ET-1水平分别为（2.29±0.60）mg/L、（90.33±6.09）μmol/L、（150.67±25.38）mg/L、（113.70±21.09）ng/L，低于对照组的（2.77±0.72）mg/L、（95.71±6.38）μmol/L、（188.76±29.80）mg/L、（132.84±26.72）ng/L，差异均有统计学意义（t=3.474、4.137、6.600、3.814，均P<0.001）。观察组术后并发症总发生率为2.17%（1/46），低于对照组的15.22%（7/46），差异有统计学意义（χ²=4.913，P=0.026）；观察组术后6个月复发率为2.63%（1/46），对照组无复发，两组复发率差异无统计学意义（P=1.000）。结论　输尿管软镜碎石取石术治疗最大径<2.5 cm的男性肾结石的结石清除率、复发率与经皮肾镜碎石取石术相比无显著差异，但术中出血量、术后住院时间、并发症发生率更低，且术后肾功能、疼痛应激指标恢复更快。

关键词:

肾结石, 男性, 输尿管软镜碎石取石术, 经皮肾镜碎石取石术, 肾功能, 疼痛应激, 复发