输尿管软镜钬激光碎石术治疗长径≥2 cm的肾结石临床分析

Clinical Analysis of Flexible Ureteroscope Holmium Laser Lithotripsy in the Treatment of Kidney Stones with Long Diameter≥2 cm

目的分析予以长径≥2 cm的肾结石患者输尿管软镜钬激光碎石术治疗的临床效果。方法简单随机选择该院2018年1月—2021年12月收治的长径≥2 cm的肾结石患者40例为研究对象,采取随机数表法分为两组。对照组16例予以经皮肾镜手术治疗,观察组24例予以输尿管软镜钬激光碎石术治疗。对比两组结石一次性清除率、围术期指标、血清肌酐水平、疼痛程度及并发症发生率。结果两组结石一次性清除率对比(93.75%vs 91.67%),差异无统计学意义(χ^(2)=0.000,P>0.05)。观察组术中出血量为(8.19±1.55)mL,低于对照组的(18.76±2.41)mL,手术时间为(68.20±9.44)min,长于对照组的(55.92±8.48)min,住院时间为(5.26±1.52)d,短于对照组的(8.57±2.21)d,差异有统计学意义(t=16.919、4.193、5.263,P<0.05)。治疗前后两组血清肌酐水平比较均差异无统计学意义(t=0.009、0.295,P>0.05);治疗后1、3 d,观察组VAS评分为(2.89±0.79)分、(1.48±0.25)分,均低于对照组的(5.62±1.25)分、(3.12±0.42)分,差异有统计学意义(t=8.482、15.501,P<0.05)。观察组并发症发生率为4.17%,低于对照组的37.50%,差异有统计学意义(χ^(2)=5.260,P<0.05)。结论在长径≥2 cm的肾结石患者治疗中,予以输尿管软镜钬激光碎石术治疗可发挥显著效果,其对比经皮肾镜手术在术中出血量及术后恢复方面更具优势,可作为经皮肾镜手术替代疗法,应用效果及安全性较高。

Objective To analyze the clinical effect of flexible ureteroscopic holmium laser lithotripsy in patients with kidney stones with a length greater than 2 cm.Methods A total of 40 patients with kidney stones with a length of≥2 cm who were admitted to the hospital from January 2018 to December 2021 were simply randomly selected as the research objects and were divided into two groups by random number table method,among them.16 cases in the control group were treated with percutaneous nephroscopic surgery,and 24 cases in the observation group were treated with flexible ureteroscopic holmium laser lithotripsy.The one-time stone clearance rate,perioperative indexes,serum creatinine level,pain degree and complication rate were compared between the two groups.Results There was no statistically significant difference in the one-time stone clearance rate between the two groups(93.75%vs 91.67%)(χ^(2)=0.000,P>0.05).The intraoperative blood loss of the observation group was(8.19±1.55)mL,which was lower than that of the control group(18.76±2.41)mL,and the operation time was(68.20±9.44)min,which was longer than that of the control group(55.92±8.48)min,the length of hospital stay was(5.26±1.52)d,which was shorter than that of the control group(8.57±2.21)d,the difference was statistically significant(t=16.919,4.193,5.263,P<0.05).There was no statistically significant difference in serum creatinine levels between the two groups before and after treatment(t=0.009,0.295,P>0.05);1 and 3 d after treatment,the VAS scores of the observation group were(2.89±0.79)points,(1.48±0.25)points were lower than those of the control group((3.12±0.42)points,and the difference was statistically significant(t=8.482,15.501,P<0.05).The incidence of complications in the observation group was 4.17%,which was lower than 37.50%in the control group,and the difference was statistically significant(χ^(2)=5.260,P<0.05).Conclusion In the treatment of renal calculi patients with long diameter≥2 cm,flexible ureteroscopic holmium laser lithotripsy can play a significant role.Compared with percutaneous nephroscopic surgery,it has more advantages in terms of intraoperative blood loss and postoperative recovery.As an alternative therapy for percutaneous nephroscopic surgery,the application effect and safety are high.