输尿管软镜钬激光碎石术治疗孤立肾肾结石

Treatment of Isolated Kidney and Kidney Stones with Ureteroscope and Holmium Laser Lithotripsy

目的:分析输尿管软镜钬激光碎石术治疗孤立肾肾结石的疗效和安全性。方法:孤立肾肾结石的患者65例,根据治疗方式回顾性分为RIRS组33例、PCN组32例。PCN组采用经皮肾镜碎石术治疗,RIRS组采用输尿管软镜钬激光碎石术治疗。观察两组手术指标(手术时长、手术出血量、下床时间、出院时间)、治疗效果和结石清除率,并发症(腰腹疼痛、血尿、结石残留)情况,并进行比较。结果:RIRS组手术时长(83.57±9.20)min、下床时间(33.71±4.22)h、出院时间(5.24±0.60)d均短于PCN组(114.73±10.48)min、(41.57±9.43)h、(8.44±2.57)d,手术出血量(195.26±8.53)mL低于PCN组(402.33±11.94)mL(P<0.05);RIRS组总有效率和结石清除率分别为88%、85%,均高于PCN组72%、56%(P<0.05);RIRS组并发症发生率为27%,低于PCN组47%(P<0.05)。结论:输尿管软镜钬激光碎石术治疗孤立肾肾结石,较经皮肾镜碎石术疗效更佳,安全性更好。

Objective To analyze the efficacy and safety of holmium laser lithotripsy under ureteroscopy in the treatment of isolated kidney and kidney stones.Methods A total of 65 patients with isolated kidney and kidney stones were enrolled and divided into RIRS group(33 cases)and PCN group(32 cases)according to the treatment.Patients in the PCN group were treated with percutaneous nephrolithotomy,and patients in the RIRS group were treated with ureteroscopic holmium laser lithotripsy.The surgical indexes(surgery duration,surgical bleeding volume,getting out of bed time and discharge time),treatment effect and stone removal rate,complications(waist and abdomen pain,hematuria and residual stones)were observed and compared.Results In RIRS group,the operation time[(83.57+9.20)min],time of getting out of bed[(33.71+4.22)h]and discharge time[(5.24+0.60)d]were shorter than those in PCN group[(114.73+10.48)min,(41.57+9.43)h and(8.44+2.57)d],and the amount of bleeding during operation[(195.26+8.53)mL]was lower than that in PCN group[(402.33+11.94)mL](P<0.05);the total effective rate and stone clearance rate in RIRS group were 88%and 85%,which were higher than those in PCN group(72%and 56%,respectively).The incidence of complications in RIRS group was 27%,which was lower than 47%in PCN group(P<0.05).Conclusion The ureteroscope holmium laser lithotripsy can be used in the treatment of patients with isolated kidney and kidney stones,the effect is better,safer,and can significantly shorten the operation time,reduce the amount of surgical bleeding,effectively remove stones and reduce postoperative complications occurrence.This method can promote the early recovery of patients,has a high clinical application value,and is worthy of application and promotion.