微创医学

目的探讨短组合式硬管镜开展超微通道经皮肾镜碎石术治疗肾下盏结石的临床疗效。方法选取2020年6月至2023年8月广西医科大学第三附属医院泌尿外科收治的100例肾下盏结石患者，按随机数字法将患者分为经皮肾镜组和输尿管软镜组，每组50例。经皮肾镜组使用短组合式硬管镜联合负压清石系统开展超微通道经皮肾镜碎石术，输尿管软镜组采用经尿道逆行输尿管软镜碎石术，评估两组患者的临床疗效及安全性指标。结果因术中原因剔除部分病例，最终纳入经皮肾镜组47例，输尿管软镜组44例。与输尿管软镜组相比，经皮肾镜组的手术时间更短，出院前结石清除率及术后1个月结石清除率更高，差异均有统计学意义（均P<0.05）。经皮肾镜组术后的血清降钙素原、C反应蛋白水平均低于输尿管软镜组，差异均有统计学意义（均P<0.05）。两组血红蛋白水平、白细胞计数及术后并发症发生率比较，差异均无统计学意义（均P>0.05）。结论短组合式硬管镜联合负压清石系统开展超微通道经皮肾镜治疗肾下盏结石具有手术时间短、结石清除率高、术后安全性好的优势，值得在临床上进一步推广应用。

Objective To investigate the clinical efficacy of super-mini-percutaneous nephrolithotripsy with short combined rigid endoscope for the treatment of lower calyceal calculus. Methods Patients with lower renal caliceal calculus admitted to the Third Affiliated Hospital of Guangxi Medical University from June 2020 to August 2023 were selected. According to the random number method, patients were divided into percutaneous nephrolithotomy group and flexible ureteroscopy group, with 50 cases in each group. The percutaneous nephrolithotomy group carried out super-mini-percutaneous nephrolithotripsy with a short combined rigid endoscope and a negative-pressure stone clearance system. The flexible ureteroscope group underwent transurethral retrograde flexible ureteroscopic lithotripsy. The clinical efficacy and safety indicators of the two groups of patients were evaluated. Results Some cases were excluded due to intraoperative factors. Eventually, 47 patients were included in the percutaneous nephrolithotomy group and 44 in the flexible ureteroscopy group. Compared with the flexible ureteroscopy group, the percutaneous nephrolithotomy group had shorter operation time, higher stone clearance rate before discharge and 1 month after operation, and all these differences were statistically significant (all P<0.05). The postoperative serum procalcitonin and C-reactive protein levels in the percutaneous nephrolithotom group were both lower than those in the flexible ureteroscopy group, with all these differences being statistically significant (all P<0.05). There were no statistically significant differences between the two groups in terms of hemoglobin level, white blood cell count, and the incidence of postoperative complications (all P>0.05). Conclusions The application of super-mini-percutaneous nephrolithotripsy with a short combined rigid endoscope and a negative-pressure stone clearance system for the treatment of lower calyceal calculus offers advantages such as a short operation time, a high stone clearance rate, and good postoperative safety. Therefore, it is worthy of further clinical promotion and application.