输尿管软镜与输尿管硬镜下钬激光碎石术治疗老年输尿管上段结石的效果观察

Effect of holmium laser lithotripsy under flexible ureteroscope and rigid ureteroscope on upper ureteral calculi in the elderly

目的探讨输尿管软镜下钬激光碎石术(FURL)与输尿管硬镜下钬激光碎石术(URL)治疗老年输尿管上段结石的临床效果。方法回顾性分析2018年10月至2020年10月本院收治的86例老年输尿管上段结石患者的临床资料,根据手术治疗方式的差异进行分组,其中实施FURL的43例患者纳入对照组,其余实施URL的患者纳入研究组,比较两组手术相关指标、机体应激指标、结石清除效果与术后并发症的差异。结果研究组手术时间和术后住院总时间均短于对照组(P<0.05);研究组术后1 d血红蛋白丢失量和住院总费用与对照组比较,差异无统计学意义(P>0.05)。研究组和对照组术后1、3、5 d的应激反应指标较本组手术前比较均有明显上升,组内比较差异有统计学意义(P<0.05)。两组术前应激反应指标水平比较,差异无统计学意义(P>0.05);研究组术后1、3、5 d的应激反应指标水平均低于对照组(P<0.05)。研究组术后第3天、术后2、4周的结石清除率均高于对照组(P<0.05)。研究组术后并发症总发生率(6.98%)低于对照组(P<0.05);两组术后6个月两组结石复发率比较,差异无统计学意义(P>0.05)。结论与URL比较,FURL治疗输尿管上段结石可以在保障结石清除效果的同时减少并发症的发生,对机体应激反应影响较小,临床治疗的有效性和安全性更理想。

Objective To explore the clinical effects of holmium laser lithotripsy under flexible ureteroscope(FURL) and holmium laser lithotripsy under rigid ureteroscope(URL) in the treatment of elderly patients with upper ureteral calculi(UUC). Methods The clinical data of 86 elderly patients with UUC admitted to our hospital from October 2018 to October 2020 were analyzed retrospectively, and they were divided into groups according to the differences of surgical treatment methods. Among them, 43 patients who received FURL were included in the control group, and the rest patients who underwent URL were included in the study group. The differences of operation-related indicators,stress reaction indexes, stone clearance effect and postoperative complications between the two groups were compared. Results The operation time and total hospitalization time of the study group were shorter than those of the control group(P<0.05).There was no significant difference between the study group and the control group in hemoglobin loss and total hospitalization expenses on the 1 st day after operation(P>0.05).The stress reaction indexes of the study group and the control group on the 1 st, 3 rd and 5 th day after operation were significantly higher than those before operation, and there was a significant difference between the two groups(P<0.05). There was no significant difference in stress reaction indexes between the two groups before operation(P>0.05).The stress reaction indexes in the study group were lower than those in the control group on the 1 st, 3 rd and 5 th day after operation(P<0.05).The stone clearance rate of the study group on the3 rd day,2 nd week and 4 th week after operation was higher than that of the control group(P<0.05).The total incidence of postoperative complications in the study group was 6.98%,lower than that in the control group(P<0.05).Six months after operation,there was no significant difference in stone recurrence rate between the two groups( P>0.05). Conclusion Compared with URL, FURL in the treatment of UCC can not only ensure the effect of calculus removal, but also reduce the occurrence of complications, and has less influence on the stress reaction of the body, thus making the clinical treatment more effective and safe.