钬激光碎石术治疗上尿路结石的疗效及肾盂内压与术后感染的临床研究

Curative effect of holmium laser lithotripsy in treatment of upper urinary tract calculi and clinical research on intrapelvic pressure and postoperative infection

目的探讨上尿路结石行输尿管软镜钬激光碎石术的效果及探讨肾盂内压与术后感染的关系。方法选择2014年8月-2015年8月在我院进行治疗的上尿路结石患者86例进行研究，对入选患者根据是否发生感染进行分组，分为感染组（n=36）、未感染组（n=50），观察比较感染组与未感染组患者的手术时间、肾盂内压、灌注泵流量、C反应蛋白（CRP）、白细胞计数。结果86例患者中，80例均顺利放置镜鞘并置入输尿管软镜，一次进镜成功率为93．0％（80／86）；软镜进镜后98．75％（79／80）成功寻及结石；感染组的肾盂内压、灌注泵流量均显著高于未感染组。差异有统计学意义（P〈0．05）。感染组患者血CRP水平、白细胞计数均显著高于未感染组，差异有统计学意义（P〈0．05）。但两组手术时间比较，差异无统计学意义（P〉0．05）。结论输尿管软镜钬激光碎石术治疗上尿路结石碎石成功率高、并发症少，另一方面，肾盂内压升高易引起术后感染，应密切监测肾盂内压，有利于提高输尿管软镜钬激光碎石术的安全性。

Objective To discuss the effect of flexible ureteroscopic holmium laser lithotripsy in treatment of upper uri- nary tract calculi and to explore the relation between intrapelvic pressure and postoperative infection. Methods 86 patients with upper urinary tract calculi treated in our hospital from August 2014 to August 2015 were selected and divided based on infection condition into the infection group（n=36） and the non-infection group（n=50）, The operation duration, intrapelvic pressure, flow of perfusion pump, CRP, and WBC were observed and compared between two groups. Results Scope sheath and flexible ureteroscope were successfully placed of 80 cases in the 86 patients, first-time success rate was 93.0%（80/86）, and 98.75%（79/80） of these cases calculi were successful detected. The intrapelvic pressure and flow of perfusion pump were significantly higher in the infection group than in the non-infection group, there was significant difference（P〈0.05）. The levels of CRP and WBC were significantly higher in the infection group than in the non-infection group, there was significant difference （P〈0.05）. There was no significant difference in operation duration between two groups（P〉0.05）. Conclusion Flexible ureteroscopic holmium laser lithotripsy has high success rate in treatment of upper urinary tract calculi with low incidence of complications. Enhanced intrapelvic pressure may cause postoperative infection, which, therefore, should be carefully monitored to improve the safety of flexible ureteroscopic holmium laser lithotripsy.