组合式输尿管硬镜联合软镜治疗2~3cm肾盂结石临床观察

Clinical effect of rigid ureteroscope combined with flexible ureteroscope in the treatment of 2-3 cm pyelolithiasis

目的 探讨组合式输尿管硬镜联合软镜治疗2~3 cm肾盂结石的临床效果,为临床治疗提供参考依据.方法 回顾性分析2017年1月至2019年5月于韩城市人民医院诊治的120例肾盂结石患者的临床资料.根据手术治疗方法 不同将患者分为观察组65例和对照组55例.观察组采用组合式输尿管硬镜联合软镜治疗,对照组采用经皮肾镜取石术治疗.比较两组患者的手术时间、出血量、住院时间、结石清除率、血红蛋白水平下降量、疼痛评分、肾功能指标及并发症发生情况.结果 观察组患者的手术时间及住院时间分别为(52.85±8.49)min、(2.28± 0.69)d,明显短于对照组患者的(73.16±12.25)min、(5.14±0.75)d,患者术中出血量为(22.86±6.54)mL,明显少于对照组的(54.45±9.39)mL,差异均有统计学意义(P<0.05);观察组和对照组患者的结石清除率分别为93.85%,90.91%,差异无统计学意义(P>0.05);观察组患者术后血红蛋白下降量、疼痛评分分别为(3.37±1.05)g/L、(3.20±1.04)分,均明显低于对照组的(10.92±2.21)g/L、(4.07±1.26)分,差异均有统计学意义(P<0.05);两组患者术后胱抑素(Cys-C)和脂质运载蛋白(NGAL)水平均明显升高,且观察组患者术后当天Cys-C、NGAL水平分别为(685.64±117.59)μg/L、(4.69± 1.15)μg/L,明显低于对照组的(797.23±136.41)μg/L、(5.57±1.38)μg/L,差异均有统计学意义(P<0.05);观察组患者术后发热发生率为1.54%,明显低于对照组的10.90%,差异有统计学意义(P<0.05);观察组患者术后输尿管损伤、大出血、感染发生率分别为0、0、1.54%,对照组患者分别为1.82%、3.64%、3.64%,差异均无统计学意义(P>0.05).结论 组合式输尿管硬镜联合软镜治疗2~3 cm肾盂结石能够有效清除结石,较经皮肾镜取石术手术时间更短、创伤更小、恢复更快、并发症少,具有推广应用价值.

Objective To investigate the clinical effect of rigid ureteroscope combined with flexible ureteroscope in the treatment of pyelonesis with 2-3 cm calculi,and provide reference for clinical treatment.Methods The clinical data of 120 patients with renal calculus,who were treated in the People's Hospital of Hancheng City from January 2017 to May 2019,were retrospectively analyzed.According to different surgical treatment methods,the patients were divided into the observation group(65 cases)and control group(55 cases).The observation group was treated with rigid ureteroscope combined with flexible ureteroscope,and the control group was treated with percutaneous nephrolithotomy.The operation time,blood loss,hospital stay,stone clearance rate,hemoglobin level decline,pain score,renal function index,and complications of the two groups were compared.Results The operation time and hospitalization time of the patients in the observation group were(52.85±8.49)min,(2.28±0.69)d,respectively,which were significantly shorter than corresponding(73.16±12.25)min and(5.14±0.75)d in the control group;the intraoperative bleeding volume was(22.86±6.54)mL,which was significantly lower than(54.45±9.39)mL in the control group;the above differences were statistically significant(all P<0.05).The stone removal rate of the observation group was 93.85%versus 90.91%of the control group(P>0.05).The decrease of hemoglobin level and pain score in the observation group were(3.37±1.05)g/L and(3.20±1.04)points,respectively,which were significantly lower than corresponding(10.92±2.21)g/L and(4.07±1.26)points in the control group(P<0.05).After operation,Cys-C and NGAL were significantly increased in both groups,and the levels of Cys-C and NGAL in the observation group were(685.64±117.59)μg/L,(4.69±1.15)μg/L,which were significantly lower than(797.23±136.41)μg/L,(5.57±1.38)μg/L in the control group(P<0.05);the incidence of postoperative fever in the observation group was 1.54%,which was significantly lower than 10.90%in the control group(P<0.05),but the incidence of ureteral injury,major bleeding,and infection in the observation group were 0,0,1.54%versus corresponding 1.82%,3.64%,3.64%in the control group(all P>0.05).Conclusion In the treatment of 2-3 cm pyelonesis,rigid ureteroscope combined with flexible ureteroscope can effectively remove stones,and has shorter operation time,less trauma,faster recovery,less complications than percutaneous nephrolithotomy.It is worthy of clinical application.