输尿管软镜下钬激光碎石术治疗≥2 cm上尿路结石临床价值分析

Clinical value of flexible ureteroscopic holmium laser lithotripsy for the treatment of upper urinary tract calculi ≥ 2 cm

目的分析微创输尿管软镜下钬激光碎石术治疗≥2 cm上尿路结石的临床价值。方法我院收治的≥2 cm上尿路结石患者120例,按照手术方式分为经皮肾镜碎石术组(PCNL组,n=53)与输尿管软镜碎石术组(FURL组,n=67),比较两组一次性结石清除率、手术时间、术中出血量、碎石能量、住院时间,检测两组手术前后不同时间血C反应蛋白(CRP)、白介素-6(IL-6)及尿肾损伤分子-1(KIM-1)水平的变化,比较两组术后舒适度评分(BCS)、视觉模拟评分(VAS)的差异及术后并发症发生情况,术后3个月均进行复查,统计结石残留、复发情况。结果两组一次性结石清除率及再次手术率比较差异无统计学意义(P> 0. 05)。FURL组术中出血量、住院时间均低于PCNL组(P <0. 05)。两组术后4、24、72 h CRP、IL-6、KIM-1均上升,且FURL组均低于PCNL组(P <0. 05)。与术后4 h比较,两组术后24、72 h BCS评分均上升,VAS评分均降低,FURL组术后4、24、72 h BCS评分均高于PCNL组,VAS评分低于PCNL组(P <0. 05)。两组术后并发症发生率比较差异无统计学意义(P> 0. 05),术后复查两组均无结石残留。结论 FURL治疗≥2 cm上尿路结石一次性根治率高,患者术中出血量低,术后住院时间短,舒适度高,疼痛程度低,并发症发生率低,安全性高。

Objective To analyze the clinical value of minimally invasive flexible ureteroscopic holmium laser lithotripsy in the treatment of upper urinary tract calculi≥2 cm.Methods One hundred and twenty patients with upper urinary tract calculi≥2 cm treated in our hospital were divided into PCNL group(percutaneous nephrolithotomy,N=53)and FURL group(flexible ureteroscopic lithotripsy,ti=67)according to different surgical methods.The one-time stone clearance rate,surgical time,intraoperative blood loss,lithotripsy energy and length of hospital stay were compared between the two groups.Changes of serum levels of C-reactive protein(CRP),interleukin-6(IL-6)and urinary kidney injury molecule-1(KIM-1)at different time before and after operation were detected in the two groups.The postoperative comfort scores(B C S)and visual analogue scale(VAS)scores were compared between the two groups,and the incidence of complications after operation was statistically analyzed.Reexamination was carried out after 3 months of the operation to observe the situation of residual stones and recurrence.Results There was no significant difference in the one-time stone clearance rate or re-operation rate between the two groups(P>0.05).The intraoperative blood loss and length of hospital stay of the FURL group were less/shorter than those of the PCNL group(P<0.05).The levels of CRP,IL-6 and KIM-1 at 4 h,2 4 h and 72 h after operation were increased in the two groups,and the increase in the FURL group was more than that in the PCNL group(P<0.05).Compared to 4 h after operation,BCS scores were increased and the VAS scores were decreased at 24 h and 72 h after operation(P<0.05).The BCS scores of the FURL group were higher and VAS scores were lower than those of the PCNL group(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05),and there were no residual stones in the two groups after operation.Conclusion FURL in the treatment of upper urinary tract calculi≥2 cm has advantages of high one-time radical rate,low intraoperative blood loss,short postoperative length of hospital stay,high patients,comfort,low pain degree and low incidence of complications as well as high safety.