【摘要】 目的 探讨探讨经皮肾镜取石术（percutaneous nephrolithotomy,PCNL）联合输尿管软镜钬激光碎石术（flexible ureterorenoscopy lithotripsy,FURL）治疗复杂铸型肾结石的效果。方法 回顾性分析2020年1月—2022年12月江西省新余市人民医院收治的105例复杂铸型肾结石患者的临床资料，根据手术方式不同分为对照组（n=50）和观察组（n=55），对照组采用PCNL治疗，观察组采用PCNL联合FURL治疗，比较两组围术期指标、一期结石清除率、肾功能、炎症因子及并发症。结果 观察组手术时间、住院时间为（103.49±10.22)min、（10.02±1.77)d，长于对照组的（85.72±7.26)min和（6.45±1.23)d，差异有统计学意义（t=10.436、11.887,P<0.05），观察组术中出血量为（105.87±11.04)mL，多于对照组的（86.25±7.03)mL，差异有统计学意义（t=10.740,P<0.05）。观察组一期结石清除率为96.36%，高于对照组的78.00%，差异有统计学意义（χ~2=8.142,P<0.05）。术前，两组肾功能水平比较，差异无统计学意义（P>0.05）；术后1周，两组肾功能水平均高于术前，但观察组肾功能水平均低于对照组，差异有统计学意义（P<0.05）。术前，两组血清炎症因子水平比较，差异无统计学意义（P>0.05）。术后3 d，两组血清炎症因子水平均高于术前，但观察组血清炎症因子水平均低于对照组，差异有统计学意义（P<0.05）；两组并发症总发生率比较，差异无统计学意义（P>0.05）。结论 PCNL联合FURL治疗复杂铸型肾结石疗效显著，可提高一期结石清除率，改善肾功能，降低炎症因子，且不增加并发症发生率，临床应用价值较高。更多还原

【Abstract】 Objective To investigate the effect of percutaneous nephrolithotomy (PCNL) combined with flexible ureterorenoscopy lithotripsy(FURL) in the treatment of complex cast renal nodule.Methods The clinical data of 105 patients with complex cast kidney stones treated in Xinyu People’s Hospital of Jiangxi Province from January 2020 to December 2022 were retrospectively analyzed.According to different surgical methods,they were divided into control group (n=50) and observation group (n=55).The control group was treated with PCNL,and the observation group was treated with PCNL combined with FURL.Perioperative indexes,primary stone clearance,renal function,inflammatory factors and complications were compared between the two groups.Results The operation time and hospital stay in the observation group were(103.49±10.22) min and (10.02±1.77) d,which were longer than those in the control group (85.72±7.26) min and (6.45±1.23) d,and the difference was statistically significant (t=10.436,11.887,P<0.05).The intraoperative blood loss in the observation group was (105.87±11.04) mL,which was higher than that in the control group (86.25±7.03) mL,and the difference was statistically significant (t=10.740,P<0.05).The first-stage stone clearance rate in the observation group was 96.36%,higher than that in the control group (78.00%),and the difference was statistically significant (χ~2=8.142,P<0.05).Before operation,there was no statistically significant difference in renal function between the two groups (P>0.05).One week after surgery,the renal function level of both groups was higher than that before surgery,but the renal function level of observation group was lower than that of control group,the difference was statistically significant (P<0.05).Before operation,there was no statistically significant difference in serum inflammatory factors between the two groups (P>0.05);3 d after surgery,the serum inflammatory factor levels in both groups were higher than before surgery,but the serum inflammatory factor levels in the observation group were lower than those in the control group,the difference was statistically significant (P<0.05).There was no statistically significant difference in the total incidence of complications between the two groups (P>0.05).Conclusion PCNL combined with FURL has significant efficacy in the treatment of complex cast kidney stones,which can increase the first-stage stone clearance rate,improve renal function,reduce inflammatory factors,and do not increase the incidence of complications,and has high clinical application value.更多还原