输尿管软镜联合硬镜治疗复杂性输尿管上段结石的效果

Effect of flexible ureteroscope combined with ureteroscope in the treatment of complicated upper ureteral calculi

目的研究输尿管软镜联合硬镜治疗复杂性输尿管上段结石的临床效果并予以分析。方法选取2014年2月～2017年2月广东省东莞市人民医院收治的复杂性输尿管上段结石患者120例,将其以随机数字表法分为观察组和对照组,每组各60例。对照组采用微创经皮肾镜治疗,观察组则采用输尿管软镜联合硬镜治疗。比较两组手术时间、术中出血量、住院时间,术后1个月与术后3个月结石清除率,术前与术后5 d血清白细胞介素-6(IL-6)与C反应蛋白(CRP)水平变化情况,术后并发症发生情况。结果观察组手术时间明显长于对照组,而术中出血量明显少于对照组,住院时间明显短于对照组,组间比较差异有统计学意义(P <0.05)。观察组术后1个月结石清除率明显高于对照组,组间比较差异有统计学意义(P <0.05);而术后3个月结石清除率两组差异无统计学意义(P> 0.05)。术后5 d观察组血清IL-6与CRP水平均明显低于对照组,差异有统计学意义(P <0.05)。观察组术后腰痛、肾盂肾炎、发热发生率与对照组比较差异无统计学意义(P> 0.05)。结论输尿管软镜联合硬镜治疗复杂性输尿管上段结石具有较好的临床效果,且安全性较高,有利于减轻患者炎性反应程度,值得临床推广应用。

Objective To study and analyze the clinical effect of flexible ureteroscope combined with ureteroscope for the treatment of complicated ureteral calculi. Methods A total of 120 patients with complicated ureteral calculi treated in Dongguan People’s Hospital of Guangdong Province from February 2014 to February 2017 were selected, they were divided into observation group(60 cases) and control group(60 cases) by random number table method. The control group was treated with minimally invasive percutaneous nephroscopy, while the observation group was treated with flexible ureteroscope combined with ureteroscope. The operation time, the intraoperative blood loss, the time of hospitalization, the clearance rate of calculi postoperative for 1 and 3 months were compared between the two groups, the level of serum interleukin-6(IL-6), C-reactive protein(CRP) before and 5 days after operation and the complications after operation were also compared. Results The operation time in observation group was longer than the control group obviously, and intraoperative blood loss was less than control group obviously, the time of hospitalization was significantly shorter than that of the control group, the differences were statistically significant(P < 0.05). The clearance rate of calculi 1 month after operation in observation group was significantly higher than that in the control group, the difference was statistically significant(P < 0.05), however, there was no significant difference between the two groups 3 months after opetation(P > 0.05). The levels of serum IL-6 and CRP in the observation group were significantly lower than the control group 5 days after operation, the differences were statistically significant(P < 0.05). The incidence of lumbago,pyelonephritis and fever after operation patients in the observation group had no significant difference compared with those in the control group(P > 0.05). Conclusion Flexible ureteroscopy combined with ureteroscope for complicated ureteral calculi has good clinical effect and high security, which is helpful to reduce the degree of inflammatory response of patients, and it is worthy of clinical application.