负压组合式输尿管镜与输尿管软镜钬激光碎石术治疗单侧上尿路结石的对比研究

Comparative study of negative pressure combined ureteroscopic lithotripsy and flexible ureteroscopy combined holmium laser lithotripsy in the treatment of unilateral upper urinary tract calculi

目的比较负压组合式输尿管镜与输尿管软镜钬激光碎石术(f-URS)治疗单侧上尿路结石的临床效果。方法选取于2018年6月至2020年6月在本院住院治疗的单侧上尿路结石患者80例,随机分为对照组和研究组,每组40例,对照组予以f-URS治疗,研究组予以负压组合式输尿管镜钬激光碎石术治疗。比较两组术后的住院天数、手术时间、结石清除率以及治疗前后的血红蛋白(Hb)、血肌酐(Cr)水平,统计两组治疗后的并发症发生率。结果研究组的手术时间长于对照组[(54.12±6.25)min比(35.41±5.73)min](P<0.05),术后24 h的结石清除率高于对照组[90.0%(36/40)比62.5%(25/40)](P<0.05),总并发症发生率低于对照组[5.0%(2/40)比25.0%(10/40)](P<0.05);两组的住院天数和术后30 d的结石清除率差异均无统计学意义(均P>0.05)。治疗后两组的Hb均低于治疗前(均P<0.05),组间比较差异无统计学意义(P>0.05);两组的Cr治疗前后及组间比较差异均无统计学意义(均P>0.05)。结论对于单侧上尿路结石的患者,负压组合式输尿管镜与f-URS都是有效的治疗方法,与f-URS比较,负压组合式输尿管镜钬激光碎石术可避免更多的并发症,且对于直径>20 mm结石的治疗效果更明显。

Objective To compare the clinical curative effect of negative pressure combined ureteroscopic lithotripsy and flexible ureteroscopy combined holmium laser lithotripsy(f-URS)on unilateral upper urinary tract calculi.Methods Eighty patients with unilateral upper urinary tract calculi who were treated in our hospital between June 2018 and June 2020 were enrolled.They were randomly divided into control group and study group,40 cases in each group.The control group was treated with f-URS,while the study group was treated with negative pressure combined ureteroscopic lithotripsy combined holmium laser lithotripsy.The hospitalization time,operation time,stone clearance rate,as well as levels of hemoglobin(Hb)and serum creatinine(Cr)before and after treatment were compared between the two groups.The incidence of complications after treatment in both groups was statistically analyzed.Results The operation time in the study group was longer than that in the control group[(54.12±6.25)min vs.(35.41±5.73)min](P<0.05),the stone clearance rate within 24 h after surgery was higher than that in the control group[90.0%(36/40)vs.62.5%(25/40)](P<0.05),and the total incidence of complications was lower than that in the control group[5.0%(2/40)vs.25.0%(10/40)](P<0.05).There were no statistically significant differences in hospitalization time and stone clearance rate within 30 d after surgery between the two groups(both P>0.05).After treatment,Hb in both groups decreased(both P<0.05),and there was no statistically significant difference in Hb between the two groups(P>0.05).There was no statistically significant difference in Cr before and after treatment,as well as between the two groups(all P>0.05).Conclusions For patients with unilateral upper urinary tract calculi,both negative pressure combined ureteroscopic lithotripsy and f-URS are effective treatment methods.Compared with f-URS,negative pressure combined ureteroscopic lithotripsy can avoid more complications,with more significantly curative effect on the stones with diameter longer than 20 mm.