输尿管软镜下钬激光碎石术对复杂性上尿路结石患者疗效及术后复发的影响

The effect of flexible ureteroscopic holmium laser lithotripsy oncurative effectandrecurrence in patients with complicated upper urinary tract stones

目的探讨输尿管软镜下钬激光碎石(FURS)术对复杂性上尿路结石患者疗效及术后复发的影响。方法将我院收治的90例复杂性上尿路结石患者,按照随机单盲分组方法分为观察组和对照组各45例,观察组采用FURS术治疗,对照组采用经输尿管镜取石(URL)术治疗,比较两组手术相关指标、炎症因子水平及术后1、3、7 d疼痛视觉模拟(VAS)评分,记录术后并发症情况,术后随访6个月,统计结石复发率。结果所有患者均顺利完成手术。与对照组相比,观察组手术时间较短、术中出血量较少、下床时间较短、结石清除率较高(P<0.05);两组术后白细胞介素6、C反应蛋白、降钙素原、肿瘤坏死因子α水平明显降低,且观察组各指标低于对照组(P<0.05);术后1 d两组疼痛VAS评分比较,差异无统计学意义(P>0.05),术后3、7 d观察组VAS评分低于对照组(P<0.05);观察组并发症总发生率低于对照组(P<0.05);术后随访6个月,观察组结石复发率低于对照组(P<0.05)。结论FURS治疗复杂性上尿路结石安全有效,相比于URL具有手术时间较短、术中出血量少、下床时间早、结石清除率高、术后炎症及疼痛反应轻、并发症少、复发率低等优势,值得临床推广。

Objective To investigate the effect of flexible ureteroscopic holmium laser lithotripsy(FURS)on curative effectandrecurrence in patients with complicated upper urinary tract stones.Methods Ninety patients with complicated upper urinary tract stones in our hospital were randomly divided into observation or control group,45 in each group.The observation group was treated with FURS while the control group was treated with ureteroscopic lithotripsy(URL).Operation-related indicators,inflammatory factors,and visual analogue scale(VAS)scores after 1,3 and 7 days of operation were compared between the two groups.Postoperative complications were recorded.The patients were followed up for 6 months after operation,and the stone recurrence rate was statically analyzed.Results The operation was completed in all patients.Compared with the control group,the observation group had a shorter operation time,less intraoperative blood loss,shorter time to get out of bed,anda higher stone clearance rate(P<0.05).After operation,the levels of interleukin 6,C-reactive protein,procalcitonin and tumor necrosis factor-αwere significantly reduced,and the levels in theobservation group were significantly lower than those in the control group(P<0.05).There was no statistically significant difference in pain VAS scores between the two groups after 1 day of operation(P>0.05),but the observation group had significantly lower pain VAS scores than the control group after 3 and 7 days of operation(P<0.05).The total incidence of complications in the observation group was significantly lower than that in the control group(P<0.05).During 6 months of follow-up,the stone recurrence rate in the observation group was significantly lower than that in the control group(P<0.05).Conclusion FURS is safe and effective in the treatment of complicated upper urinary tract stones.Compared with URL,it has the advantages of shorter operation time,less intraoperative blood loss,earlier time to get out of bed,higher stone clearance rate,milder postoperative inflammation and pain,fewer complications,and lower recurrence rate.Therefore,it is worthy of clinical promotion.