Analysis of the Efficacy of Minimally Invasive Percutaneous Nephrolithotomy Combined with Flexible Ureteroscopic Lithotripsy in the Treatment of Complex Renal Calculi
Yang Shibin
Liu Yi
Zeng Tiebing
Abstract：Methods:A prospective study was conducted,enrolling 169 patients with complex renal calculi admitted to Yibin Second People's Hospital from January 2020 to August 2022.According to the random number table method,the pa-tients were divided into the percutaneous nephrolithotomy group(56 cases),the flexible ureteroscope group(57 cases),and the combined group(56 cases).All groups were followed up for 2 years after surgery.The t-test or χ² test was used to com-pare the clinical efficacy,surgery-related indicators,renal function,levels of high-sensitivity C-reactive protein(hs-CRP),tumor necrosis factor(TNF)-α,angiotensin(Ang)Ⅰ,and Ang Ⅱ at 24 hours before and after surgery,as well as complica-tions at 1 month and 2 years after surgery and stone clearance at 7 days after surgery among the groups.Results:The total clinical effective rate of the combined group(92.86%)was higher than that of the percutaneous nephrolithotomy group(69.64%)and the flexible ureteroscope group(70.18%),with statistically significant differences(P<0.05).The operation time and lithotripsy time in the combined group were longer than those in the flexible ureteroscope group and the percutane-ous nephrolithotomy group;the lithotripsy time in the flexible ureteroscope group was longer than that in the percutaneous nephrolithotomy group.The exhaust time and hospital stay in the combined group were shorter than those in the flexible ure-teroscope group and the percutaneous nephrolithotomy group;the flexible ureteroscope group had shorter times than the per-cutaneous nephrolithotomy group,with statistically significant differences in all the above indicators(P<0.05).At 24 hours after surgery,the serum levels of β2-microglobulin(BMG),blood urea nitrogen(BUN),neutrophil gelatinase-associated li-pocalin(NGAL),serum creatinine(Scr),and urinary kidney injury molecule-1(KIM-1)in all groups were increased com-pared with those before surgery,and the combined group had lower levels than the flexible ureteroscope group and the percu-taneous nephrolithotomy group(P<0.05).At 24 hours after surgery,the serum levels of hs-CRP,TNF-α,Ang Ⅰ,and Ang Ⅱin all groups were higher than those before surgery,and the combined group had lower levels than the flexible ureteroscope group and the percutaneous nephrolithotomy group,with statistically significant differences(P<0.05).The stone clearance rate in the combined group(89.29%)was higher than that in the percutaneous nephrolithotomy group(64.29%)and the flexi-ble ureteroscope group(66.67%),with statistically significant differences(P<0.05).Conclusion:Minimally invasive per-cutaneous nephrolithotomy combined with flexible ureteroscopic lithotripsy and stone extraction has more advantages in alle-viating inflammatory stress response,protecting renal function,and improving stone clearance rate in the treatment of com-plex renal calculi.Objective:To analyze the clinical efficacy of minimally invasive percutaneous nephrolithotomy(mPCNL)alone and in combination with flexible ureteroscopic lithotripsy(fURL)in the treatment of patients with complex renal calculi.
Keywords：complex renal calculipercutaneous nephrolithotomyflexible ureteroscoperenal function
Publication Date：2025-08-28
Online Publishing Date：2025-10-22(First online date of this platform, not the publication date of the document)
Pages：6( 232-237 )