输尿管软镜钬激光碎石术治疗输尿管结石伴肾积水的有效性及安全性分析

郭营利; 俞健; 沈俊文

doi:10.16766/j.cnki.issn.1674-4152.002898

输尿管软镜钬激光碎石术治疗输尿管结石伴肾积水的有效性及安全性分析

doi: 10.16766/j.cnki.issn.1674-4152.002898

1.
上海瑞金医院舟山分院泌尿外科，浙江舟山 316000
2.
湖州市第一人民医院泌尿外科，浙江湖州 313099

基金项目:

浙江省医药卫生科技计划项目 2020KY937

详细信息

通讯作者:
郭营利，E-mail：2895787783@qq.com

中图分类号: R693.4R692.2
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- 被引次数: 0
出版历程
- 收稿日期: 2022-10-20
- 网络出版日期: 2023-04-19

Efficacy and safety of flexible ureteroscopic holmium laser lithotripsy in the treatment of ureteral calculi with hydronephrosis

GUO Yinli^{1
, ,},
YU Jian¹,
SHEN Junwen²

1.
Department of Urology Surgery, Zhoushan Branch of Shanghai Ruijin Hospital, Zhoushan, Zhejiang 316000, China

摘要

摘要: 目的输尿管软镜钬激光碎石术(FUHLL)为一种利用自然解剖通道到达病灶的微创手术，该术式可迅速解除梗阻，本研究探讨FUHLL治疗输尿管结石伴肾积水的有效性及安全性。方法选取2020年1月—2021年12月于上海瑞金医院舟山分院接受治疗的280例输尿管结石伴肾积水患者，使用随机数表法将患者分为观察组(140例)和对照组(140例)，观察组进行FUHLL治疗，对照组进行输尿管硬镜钬激光碎石术(UHLL)治疗。治疗前及治疗后3 d检测2组肾功能指标及血清炎性因子水平，于术后1、2、3 d应用VAS量表评价患者疼痛程度，比较2组结石清除情况及手术相关指标。结果与对照组比较，观察组治疗后血清IL-10、IL-6、PCT及CRP水平明显较低[(17.59±4.35)ng/L vs.(20.16±5.08)ng/L、(12.52±3.17)ng/L vs. (16.97±5.29)ng/L、(19.76±4.13)ng/L vs. (22.53±4.91)ng/L、(11.76±2.24)mg/L vs. (16.31±3.19)mg/L，均P < 0.05]；与对照组比较，观察组治疗后血清促肾上腺皮质激素明显较低(P < 0.05)。2组治疗后尿素氮及血肌酐水平比较差异无统计学意义(均P＞0.05)。与对照组比较，观察组术后1、2、3 d的VAS评分较低(P < 0.05)。2组术中出血量、手术时间、住院时间比较差异有统计学意义(均P < 0.05)，住院费用、结石一次清除成功率比较差异无统计学意义(均P>0.05)；观察组术后并发症发生率低于对照组(P < 0.05)。结论 FUHLL与UHLL均可有效治疗输尿管结石伴肾积水，但FUHLL治疗的手术创伤较小，更利于患者术后炎性反应与疼痛程度的减轻，保护肾功能，减少术后并发症。
- 输尿管软镜 /
- 钬激光碎石术 /
- 输尿管结石 /
- 肾积水
Abstract: Objective Flexible ureteroscopic holmium laser lithotripsy (FUHLL) was a minimally invasive operation that uses natural anatomical channels to reach the lesion, and can quickly relieve the obstruction. This study aims to explore the efficacy and safety of FUHLL in the treatment of ureteral calculi with hydronephrosis. Methods A total of 280 cases of ureteral calculi with hydronephrosis treated in Zhoushan Branch of Shanghai Ruijin Hospital from January 2020 to December 2021 were randomly divided into observation group (140 cases) and control group (140 cases). The observation group was treated with FUHLL, and the control group was treated with ureteroscopic holmium laser lithotripsy (UHLL). The renal function indexes and serum inflammatory factor levels of the two groups were measured before and 3 days after treatment. The pain degree was evaluated with visual analogue scale (VAS) scale on the first, second and third days after operation. The stone clearance and operation related indexes were compared between the two groups. Results Compared with the control group, the serum levels of IL-10, IL-6, PCT and CRP in the observation group were significantly lower after treatment [(17.59±4.35) ng/L vs. (20.16±5.08) ng/L, (12.52±3.17) ng/L vs. (16.97±5.29) ng/L, (19.76±4.13) ng/L vs. (22.53±4.91) ng/L, (11.76±2.24) mg/L vs. (16.31±3.19) mg/L, all P < 0.05]. Compared with the control group, the serum adrenocorticotrophin (ACTH) in the observation group were significantly lower after treatment (P < 0.05). While there was no significant difference in serum urea nitrogen and blood creatinine levels between the two groups after treatment (all P>0.05). Compared with the control group, the VAS scale scores after surgery were lower in the observation group at 1 d, 2 d and 3 d after operation (P < 0.05). The amount of intraoperative bleeding, duration of surgery and length of hospital stay between the two groups were significantly different (all P < 0.05). There was no significant difference in hospitalization costs and successful rate of one-time stone removal between the two groups (all P>0.05). Compared with the control group, the incidence of postoperative complications in the observation group was lower (P < 0.05). Conclusion Both FUHLL and UHLL can effectively treat ureteral calculi with hydronephrosis. However, the surgical trauma of FUHLL is less, which can reduce the postoperative inflammatory response and pain, and it is beneficial to protect renal function and reduce postoperative complications.
- Flexible ureteroscopy /
- Holmium laser lithotripsy /
- Ureteral calculi /
- Hydronephrosis

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表 1 2组输尿管结石伴肾积水患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with ureteral calculi and hydronephrosis

组别	例数	性别(例)		年龄 (x±s，岁)	结石直径 (x±s，cm)	结石部位(例)
组别	例数	男性	女性	年龄 (x±s，岁)	结石直径 (x±s，cm)	左侧	右侧
观察组	140	81	59	42.18±3.46	1.43±0.27	66	74
对照组	140	77	63	41.62±4.05	1.41±0.22	73	67
统计量		0.232^a		1.244^b	0.679^b		0.700^a
P值		0.630		0.215	0.497		0.403
注：^a为χ²值，^b为t值。

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表 2 2组输尿管结石伴肾积水患者血清炎性因子水平比较(x±s)

Table 2. Comparison of serum inflammatory factor levels between the two groups of patients with ureteral calculi and hydronephrosis(x±s)

组别	例数	IL-10(ng/L)		IL-6(ng/L)		PCT(ng/L)		CRP(mg/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	140	9.15±2.26	17.59±4.35^a	3.15±1.06	12.52±3.17^a	13.91±2.72	19.76±4.13^a	4.61±0.56	11.76±2.24^a
对照组	140	9.34±2.17	20.16±5.08^a	3.22±0.97	16.97±5.29^a	14.03±2.85	22.53±4.91^a	4.57±0.63	16.31±3.19^a
t值		0.718	4.547	0.576	8.538	0.360	5.108	0.561	13.445
P值		0.474	< 0.001	0.565	< 0.001	0.719	< 0.001	0.575	< 0.001
注：与同组治疗前比较，^aP < 0.05。

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表 3 2组输尿管结石伴肾积水患者肾功能相关指标比较(x±s)

Table 3. Comparison of renal function related indicators between the two groups of patients with ureteral calculi and hydronephrosis(x±s)

组别	例数	BUN(mmol/L)		ACTH(ng/mL)		SCr(μmol/L)
组别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	140	6.43±1.35	6.85±1.17	21.78±2.45	29.41±4.36^a	74.65±10.34	79.27±12.26
对照组	140	6.40±1.41	6.92±1.35	22.43±3.31	34.77±5.49^a	75.13±9.81	80.54±13.22
t值		0.182	0.464	1.868	9.046	0.398	0.833
P值		0.856	0.643	0.063	< 0.001	0.691	0.405
注：与同组治疗前比较，^aP < 0.05。

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表 4 2组输尿管结石伴肾积水患者VAS量表评分比较(x±s，分)

Table 4. Comparison of VAS scores between the two groups of patients with ureteral calculi and hydronephrosis(x±s, points)

组别	例数	术后1 d	术后2 d	术后3 d	F值	P值
观察组	140	5.12±1.65	4.37±1.13	2.27±0.83	3.079	0.016
对照组	140	6.03±1.48	5.25±1.32	4.03±1.09	2.764	0.035
t值		4.858	5.992	15.200
P值		< 0.001	< 0.001	< 0.001

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表 5 2组输尿管结石伴肾积水患者手术相关指标比较

Table 5. Comparison of surgical related indicators between the two groups of patients with ureteral calculi and hydronephrosis

组别	例数	术中出血量 (x±s，mL)	手术时间 (x±s，min)	住院时间 (x±s，d)	住院费用 (x±s，元)	结石一次清除成功[例(%)]
观察组	140	13.64±2.25	41.73±5.38	4.49±1.13	13 319.65±274.13	137(97.86)
对照组	140	22.19±4.16	56.24±7.23	7.81±1.42	13 284.71±255.49	135(96.43)
统计量		21.390^a	19.051^a	21.646^a	1.103^a	0.129^b
P值		< 0.001	< 0.001	< 0.001	0.271	0.720
注：^a为t值，^b为χ²值。

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