孙氏末端可弯硬性输尿管肾镜与微创经皮肾镜治疗老年输尿管上段嵌顿性结石的疗效对比

Comparison of suns tip-flexible ureterorenoscopy and minimally invasive percutaneous nephrolithotomy in the treatment for senile upper ureteral incarcerated calculi

目的探讨孙氏末端可弯硬性输尿管肾镜与微创经皮肾镜在治疗老年输尿管上段嵌顿性结石的疗效对比.方法选取徐州医科大学附属淮安医院泌尿外科2016年7月至2017年12月符合病例入选标准的60例老年输尿管上段嵌顿性结石患者为研究对象.按入院就诊先后顺序分为孙氏镜组(30例)和微创经皮肾镜组(30例),分别采用孙氏镜碎石术和微创经皮肾镜碎石术治疗.对两组患者一次性成功率及结石清除率、术中出血量、术后住院天数、术后并发症、术后患者舒适度、疼痛度及创伤指标(TNF-α、IL-6和CRP)等进行比较.结果两组患者一期手术均获得成功,两组术后1个月结石清除率差异无统计学意义(P<0.05);孙氏镜组术中出血量、术后住院时间及术后并发症发病率明显低于微创经皮肾镜取石组(P<0.05);孙氏镜组术后6、12、24、48 h的疼痛评分明显低于微创就经皮肾镜组(P<0.05),而舒适度评分明显高于微创经皮肾镜组(P<0.05).两组患者术后血清TNF-α、IL-6及CRP 24 h后均升高,但72 h后下降,不同时间点经皮肾镜组明显高于孙氏镜组(P<0.05).结论使用孙氏末端可弯硬性输尿管肾镜与微创经皮肾镜在处理老年输尿管上段嵌顿性结石方面均有着较高的碎石效率,但孙氏镜并具有创伤小、并发症低以及较高的舒适度等优势,值得临床广泛推广运用.

Objective To compare the efficacy of Suns tip-flexible ureterorenoscopy and minimally invasive percutaneous nephroscopy in the treatment of incarcerated upper ureteral calculi in elderly patients.Methods From July 2016 to December 2017,60 elderly patients with upper ureteral incarcerated calculi were selected from the department of urology of the Huaian hospital affiliated to Xuzhou medical university.According to the order of hospitalization,it was divided into the Suns tip-flexible ureterorenoscopy(30 cases)and the minimally invasive percutaneous nephroscope(30 cases),respectively,with Suns tip-flexible ureterorenoscopy and minimally invasive percutaneous nephrolithotomy.The one-time success rate,stone clearance rate,intraoperative bleeding volume,postoperative hospital stay,postoperative complications,postoperative comfort,pain and trauma index(TNFa,IL-6 and CRP)were compared between the two groups.Results The two groups were successful in the first stage operation,and there was no significant difference between the two groups after 1 month of operation(P>0.05).The intraoperative bleeding volume,postoperative hospitalization time and incidence of postoperative complications in the Sun s tip-flexible ureterorenoscopy group were significantly lower than those in the minimally invasive percutaneous nephrolithotomy group(P<0.05),and the pain scores in the Suns tip-flexible ureterorenoscopy group were significantly lower than those in the minimally invasive percutaneous nephrolithotomy group(P<0.05),while the comfort scores were significantly higher than those in the minimally invasive percutaneous nephrolithotomy group(P<0.05).The levels of serum TNF-a,IL-6 and CRP in both groups increased 24 hours after operation,but decreased 72 hours later.The levels of TNF-a,IL-6 and CRP in percutaneous nephroscopy group were significantly higher than those in Suns tip-flexible ureterorenoscopy group at different time points(P<0.05).Conclusions Sun s tip-flexible ureterorenoscopy and minimally invasive percutaneous nephroscope both have high lithotripsy efficiency in the treatment of incarcerated upper ureteral calculi in the elderly,but Suns tip-flexible ureterorenoscopy has the advantages of small trauma,low complications and high comfort,which is worthy of wide clinical application.