输尿管镜下气压弹道治疗输尿管结石疗效及安全性研究

Efficacy and safety of ureteroscopic pneumatic trajectory in the treatment of ureteral calculi

目的探讨输尿管镜下气压弹道碎石术与常规体外冲击波碎石术治疗输尿管结石效果及安全性。方法回顾性分析82例输尿管结石患者临床资料,根据手术方案分为常规组(n=41)与输尿管镜组(n=41)。输尿管镜组采取输尿管镜下气压弹道碎石术,常规组采取常规体外冲击波碎石术。统计两组术后1周及1个月结石清除率;术前、术后12 h、术后24 h时血清3-甲基-4-羟基苯乙二醇(MHPG)、降钙素原(PCT)、胱抑素C(CysC)水平;术前及术后1个月生活质量(SF-36)分值;并发症(呕吐恶心、肾区疼痛、发热、血尿)发生率。结果输尿管镜组术后1周及1个月时结石清除率高于常规组(χ^2分别=6.21、7.29,P均<0.05)。术后12 h和术后24 h输尿管镜组血清MHPG水平高于常规组,PCT、CysC水平低于常规组(t分别=9.91、24.56、11.79;20.32、8.68、7.26,P均<0.05)。术后1个月两组SF-36分值高于术前,且输尿管镜组术后1个月SF-36评分高于常规组(t分别=13.82、9.18、5.41,P均<0.05)。输尿管镜组呕吐恶心、肾区疼痛、发热发生率低于常规组(χ~2分别=6.61、7.41、7.76,P均<0.05),输尿管镜组血尿发生率与常规组比较,差异无统计学意义(χ^2=0.26,P>0.05)。结论采取输尿管镜下气压弹道碎石术治疗输尿管结石,其结石清除效果优于常规体外冲击波碎石术,且手术时间较短,利于减轻机体损伤程度,改善患者生活质量,且可降低并发症发生风险,安全性较高。

Objective To compare the efficacy and safety between ureteroscopic pneumatic lithotripsy and conventional extracorporeal shock wave lithotripsy in the treatment of ureteral calculi. Methods The clinical data of 82 patients with ureteral calculi were retrospectively analyzed. According to the surgical plan,they were divided into the conventional group and the ureteroscope group with 41 cases in each.The ureteroscope group underwent ureteroscopic pneumatic lithotripsy,and the conventional group underwent conventional extracorporeal shock wave lithotripsy.The calculus clearance rates at 1 week and 1 month after operation,serum levels of 3-methyl-4-hydroxyphenylethylene glycol(MHPG),procalcitonin(PCT),cystatin C(CysC) before surgery,12 hours and 24 hours after surgery,quality of life(SF-36)scores before and 1 month after operation,complications incidence rate within one month between two groups were compared. Results The calculus clearance rates were higher in the ureteroscopy group than the conventional group at 1 week and 1 month after operation(χ^2=6.21,7.29,P<0.05).Twelve hours and 24 hours after operation,the serum MHPG level was higher in the ureteroscope group than the conventional group,while the PCT and CysC levels were lower than those in the conventional group(t=9.91,24.56,11.79;20.32,8.68,7.26,P<0.05).The scores of SF-36 in the two groups were higher than those before surgery,and the increase degree of ureteroscopy group was more significant(t=13.82,9.18,5.41,P<0.05).The incidences of vomiting,nausea,pain in the kidney and fever in the ureteroscope group were lower than those in the conventional group(χ^2=6.61,7.41,7.76,P<0.05),but there was no significant difference in the incidence of hematuria between the two groups(χ^2=0.26,P>0.05). Conclusions Ureteroscopy with pneumatic lithotripsy for ureteral calculi is superior to conventional extracorporeal shock wave lithotripsy with higher calculus clearance rate and shorter operation time.It is beneficial to reduce the degree of body damage,improve the quality of life of patients,and reduce complications.