负压吸引鞘联合输尿管软镜对复杂性上尿路结石的有效性和安全性分析

Efficacy and safety analysis of negative pressure suction sheath combined with flexible ureteroscope for complicated upper urinary tract stones

目的探究负压吸引鞘联合输尿管软镜对复杂性上尿路结石(UUC)的有效性和安全性。方法选取2020年7月-2022年11月本院收治的86例复杂性UUC患者,根据随机数字表法分为两组,即对照组(n=43)、观察组(n=43),对照组进行常规输尿管软镜碎石术(FURL),观察组进行负压吸引鞘联合FURL治疗;比较两组手术相关指标、术后2d及30d的结石清除率(SFR);比较两组手术过程中肾盂内压(肾盂内压最小值、最大值及平均值);于术前、术后1d,比较两组感染相关指标[白细胞计数(WBC)、降钙素原(PCT)]、肾功能指标[血肌酐(Scr)、血尿素氮(BUN)];并比较两组术后并发症发生情况。结果观察组手术用时、住院时间均短于对照组,有统计学差异(P<0.05);观察组术后2d的SFR高于对照组,且术后并发症发生率低于对照组,均有统计学差异(P<0.05);两组术后30d的SFR比,无统计学差异(P>0.05);观察组术中肾盂内压最小值、最大值及平均值均小于对照组,有统计学差异(P<0.05)。术后1 d,两组PCT、WBC、Scr、BUN值均较术前升高,但观察组低于对照组,有统计学差异(P<0.05)。结论负压吸引鞘联合输尿管软镜应用于复杂性UUC患者中,能够提高结石清除有效率,稳定术中肾盂内压,减轻术后感染及肾损伤,且可缩短手术时间,降低并发症发生率,安全性较好。

Objective To explore the efficacy and safety of negative pressure suction sheath combined with flexible ureteroscope on complicated upper urinary calculi(UUC).Methods:A total of 86 patients with complex UUC admitted to our hospital from July 2020 to November 2022 were selected and divided into two groups according to the random number table method,namely the control group(n=43)and the observation group(n=43).The control group was treated with conventional flexible ureteroscopic lithotripsy(FURL),and the observation group was treated with negative pressure suction sheath combined with FURL.The operation related indexes,stone clearance rate(SFR)at 2 d and 30 d after operation were compared between the two groups.The renal pelvic pressure(the minimum,maximum and average values of renal pelvic pressure)during the operation were compared between the two groups.The infection-related indexes[white blood cell count(WBC),procalcitonin(PCT)]and renal function indexes[serum creatinine(Scr),blood urea nitrogen(BUN)]were compared between the two groups before operation and 1 day after operation.The postoperative complications of the two groups were compared.Results The operative time and hospital stay of the observation group were statistically different(P<0.05);the SFR of 2d was higher than the control group,and the postoperative complications was lower than the control group,which were statistically different(P<0.05);the intraoperative bleeding and the SFR ratio of 30d were not different(P>0.05);the minimum,maximum,and mean values in the observation group were all smaller than those of the control group,and statistically different(P<0.05).At 1 d after surgery,the PCT,WBC,Scr,and BUN values were higher compared with the preoperative values,but the observation group was lower than the control group,which showed statistical difference(P<0.05).Conclusion Negative pressure suction sheath combined with soft ureteroscope in patients with complicated UUC can improve the efficiency of stone removal,stabilize the intraoperative renal pelvis pressure,reduce postoperative infection and renal injury,shorten the operation time,reduce the complication rate,and have good safety.