输尿管软镜下钬激光碎石术治疗小于2cm肾结石的效果观察

Efficacy of holmium laser lithotripsy through flexible ureteroscope in treatment of kidney stones smaller than 2 cm

目的:分析电子输尿管软镜下钬激光碎石治疗<2 cm肾结石的疗效.方法:将成都市第三人民医院泌尿外科2016年1月-2019年4月收治的217例肾结石患者分为观察组(99例)接受电子输尿管软镜下钬激光碎石术,对照组(108例)接受经皮肾镜下钬激光碎石术.比较两组患者手术相关情况、不同时间点的尿肾损伤分子-1(KIM-1)及胱抑素C(Cys-C)水平、机体应激反应指标水平;并统计围术期并发症发生率.结果:观察组术后住院时间较对照组短,术后血红蛋白下降值、一期结石清除率显著低于对照组(P<0.05);术后6~48 h两组尿KIM-1、Cys-C水平较术前均有不同程度上升,但观察组术后24、48 h的尿KIM-1水平显著低于对照组,术后12、24、48、72 h的血Cys-C水平显著高于对照组(P<0.05);术后两组血管紧张素-Ⅱ(Ang-Ⅱ)、皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(AD)较术前均显著上升,但观察组Ang-Ⅱ、NE、AD、Cor均显著低于对照组(P<0.05);两组围术期并发症发生率(6.06%vs.10.19%)差异无统计学意义(P>0.05).结论:相对于经皮肾镜下钬激光碎石术,电子输尿管软镜下钬激光碎石对肾功能的影响更小,具更低的机体应激反应,但一期结石清除率较低,值得临床重视.

Objective:To analyze the efficacy of holmium laser lithotripsy through flexible ureteroscope in treatment of kidney stones smaller than 2 cm.Methods:A total of 217 patients with kidney stones who were treated in Urology Department of our hospital between January 2016 and April 2019 were divided into the observation group(treated with holmium laser lithotripsy through flexible ureteroscope,n=99)and the control group(treated with percutaneous nephroscopic holmium laser lithotripsy,n=108)according to the surgical procedures.Operation related conditions,levels of urine kidney injury molecule-1(KIM-1),Cystatin C(Cys-C)and stress response indicators at different time points were compared between the two groups.The incidence of perioperative complications was statistically analyzed.Results:Postoperative hospital stay was shorter,and the postoperative decreased value of hemoglobin and one-stage stone removal rate were significantly lower in the observation group than those in the control group(P<0.05).Urine KIM-1 and Cys-C levels in both groups increased 6-48 h after operation.However,urine KIM-1 levels in the observation group at 24 h and 48 h after operation were significantly lower than those in the control group.The blood Cys-C levels at 12 h,24 h,48 h and 72 h after operation were significantly higher than those in the control group(P<0.05).Angiotensin-II(Ang-Ⅱ),cortisol(Cor),norepinephrine(NE)and adrenaline(AD)were increased significantly after operation,but they were significantly lower in the observation group than in the control group(P<0.05).There were no statistically significant differences in incidence of perioperative complications between the two groups(6.06%vs.10.19%,P>0.05).Conclusion:Compared with percutaneous nephroscopic holmium laser lithotripsy,holmium laser lithotripsy through flexible ureteroscope has less effect on renal function,with milder stress response.However,the one-stage stone clearance rate is lower.