输尿管软镜钬激光碎石术治疗单侧输尿管上段结石的临床效果

Effect of Flexible Ureteroscopic Holmium Laser Lithotripsy on Unilateral Upper Ureteral Calculi

目的探讨输尿管软镜钬激光碎石术(FURL)治疗单侧输尿管上段结石的临床效果。方法选取单侧输尿管上段结石患者84例,按随机数字表法分为2组:对照组42例予以经皮肾镜取石术(PCNL),观察组42例予以输尿管软镜钬激光碎石术(FURL)。比较2组手术效果(住院时间、手术时间、结石清除率)、并发症发生率、手术前后肾功能[血肌酐(Scr)、血尿素氮(BUN)、β2-微球蛋白(β2-MG)]及氧化应激水平[促血管生成素-Ⅱ(Ang-Ⅱ)、皮质醇(Cor)、内皮素-1(ET-1)、血红素氧合酶-1(HO-1)]。结果与对照组比较,观察组住院时间显著缩短,手术时间显著延长,结石清除率显著升高(均P<0.001)。2组术前肾功能(β2-MG、Scr、BUN)、氧化应激水平(Ang-Ⅱ、Cor、ET-1、HO-1)比较,差异无统计学意义(P>0.05);与对照组比较,观察组术后上述指标水平均显著降低(均P<0.05)。与对照组比较,观察组并发症发生率显著降低(P<0.05)。结论FURL治疗单侧输尿管上段结石,可延长手术时间,缩短住院时间,提高结石清除率,保护肾功能,调节氧化应激反应,减少并发症发生风险。

Objective To analyze the effect of flexible ureteroscopic holmium laser lithotripsy(FURL)on unilateral upper ureteral calculi.Methods A total of 84 patients with unilateral upper ureteral calculi were randomly assigned to receive either percutaneous nephrolithotomy(control group)or FURL(observation group),with 42 patients in each group.Surgery outcomes(hospital stay,operation time and stone clearance rate),complications,renal function indexes(serum creatinine(Scr),blood urea nitrogen(BUN)and β2-microglobulin(β2-MG)),and oxidative stress indicators(angiopoietin-Ⅱ(Ang-Ⅱ),cortisol(Cor),endothelin-1(ET-1)and heme oxygenase-1(HO-1))were compared between the two groups.Results Compared with the control group,hospital stay was shortened,operation time was prolonged,and stone clearance rate was increased in the observation group(P<0.001).There were no significant differences in the levels of β2-MG,Scr,BUN,Ang-Ⅱ,Cor,ET-1 and HO-1 between the two groups before operation(P>0.05).However,the levels of these indexes in the observation group were lower than those in the control group after operation(P<0.05).In addition,the incidence of complications in the observation group were lower than that in the control group(P<0.05).Conclusion FURL can prolong operation time,shorten hospital stay,improve stone clearance rate,protect renal function,regulate oxidative stress response,and reduce the risk of complications in patients with unilateral upper ureteral calculi.