钬激光腔内与经皮肾镜取石术治疗已放置输尿管支架上尿路结石患者的疗效研究

Therapeutic effect of endoluminal holmium laser lithotripsy and percutaneous nephrolithotomy for patients with upper urinary calculi who have placed ureteral stent

目的探讨钬激光腔内与经皮肾镜取石术治疗已放置输尿管支架上尿路结石患者的疗效,为临床诊治提供依据。方法选取2017年12月至2018年12月在西安市长安医院泌尿外科就诊的已放置输尿管支架的上尿路结石患者94例进行研究,采用随机数表法分为观察组和对照组各47例。对照组患者实施经皮肾镜取石术治疗,观察组患者实施钬激光腔内碎石治疗。比较两组患者的手术时间、住院时间、住院费用、留置导管时间、术后疼痛及血清蛋白水平,统计并比较两组患者的并发症和上尿路结石清除情况。结果观察组患者的手术时间和住院时间分别为(56.46±12.73) min、(4.58±1.17) d,明显短于对照组的(69.45±12.75) min、(5.69±1.19) d,差异均有统计学意义(P<0.05);观察组患者的留置导管时间、术后疼痛及血清蛋白水平分别为(3.65±1.20) d、(3.97±0.45)分、(4.58±1.01) g/L,明显低于对照组的(5.86±1.30) d、(4.80±0.46)分、(6.09±1.07) g/L,差异均有统计学意义(P<0.05);观察组患者的并发症发生率为6.38%,明显低于对照组的21.28%,差异有统计学意义(P<0.05);观察组患者的上尿路结石清除率为95.74%,明显高于对照组的76.60%,差异有统计学意义(P<0.05)。结论钬激光腔内与经皮肾镜取石术均可治疗已放置输尿管支架的上尿路结石,但采取钬激光腔内治疗的结石清除率更高,且术后并发症更少,还能有效缩短患者的手术及住院时间,减轻患者经济负担,值得临床推广使用。

Objective To investigate the effect of Endoluminal holmium laser lithotripsy and percutaneous nephrolithotomy in the treatment of patients of upper urinary calculi with ureteral stent, and to provide theoretical basis for clinical diagnosis and treatment. Methods Ninety-four patients with upper urinary calculi with ureteral stent placed from December 2017 to December 2018 in Department of Urology, Xi’an Chang’an Hospital, were selected for study.The patients were divided into observation group and control group by random number table method, with 47 patients in each group. The patients in the control group received percutaneous nephrolithotomy, while those in the observation group were treated with endoluminal holmium laser lithotripsy. The operation time, length of hospital stay, hospitalization cost, indwelling catheter time, postoperative pain, and serum protein levels were compared between the two groups,and the complication and upper urinary stone removal were also compared. Results The operation time, length of hospital stay in the observation group were(56.46 ± 12.73) min and(4.58 ± 1.17) d, which were significantly lower than(69.45±12.75) min and(5.69±1.19) d in the control group(P<0.05). The indwelling catheter time, postoperative pain,and serum protein levels in the observation group were(3.65±1.20) d,(3.97±0.45) points,(4.58±1.01) g/L, which were significantly lower than(5.86±1.30) d,(4.80±0.46) points,(6.09±1.07) g/L in the control group(P<0.05). The incidence of complications in the observation group was 6.38%, which was significantly lower than 21.28% in the control group(P<0.05). The removal rate of upper urinary calculi in the observation group was 95.74%, which was significantly higher than 76.60% in the control group(P<0.05). Conclusion The holmium laser lithotripsy and percutaneous nephrolithotomy both can treat patients of upper urinary calculi with ureteral stent placed, however, holmium laser lithotripsy results in higher removal rate of upper urinary calculi, less postoperative complications, shortened operation and hospitalization time, and reduced financial burden, which is worthy of clinical promotion.