大功率钬激光联合负压清石鞘在微通道经皮肾镜取石术治疗上尿路结石中的有效性和安全性

Efficacy and safety of high-power holmium laser combined with negative pressure debridement in the treatment of upper urinary tract calculi by microchannel percutaneous nephrolithotomy

目的探究大功率钬激光联合负压清石鞘在微通道经皮肾镜取石术(mPCNL)治疗上尿路结石的效果。方法前瞻性选取2017年3月到2021年3月成都医学院第二附属医院·核工业416医院收治的80例上尿路结石患者作为研究对象,采用随机数字表法将其分为观察组(大功率钬激光联合负压清石鞘治疗)与对照组(常规mPCNL治疗)两组,每组各40例。比较两组患者的手术指标、手术前后肾功能指标、氧化应激指标,随访患者结石清除率及并发症发生率。结果观察组患者手术时间、术后尿液转清及住院时间为(75.29±7.74)min、(42.52±4.23)h、(8.12±1.24)d,均短于对照组[(103.58±10.63)min、(134.22±14.23)h、(12.44±2.16)d],术中出血量为(96.82±10.14)mL,少于对照组[(134.22±14.23)mL],差异均有统计学意义(P<0.05)。术前,两组肌酐、尿素氮水平相比,差异均无统计学意义(P>0.05);术后,观察组肌酐、尿素氮水平为(97.28±10.25)、(6.01±0.35)μmol/L,均低于对照组[(104.82±11.53)、(6.55±0.41)μmol/L],差异均有统计学意义(P<0.05)。术前,两组患者皮质醇、去甲肾上腺素比较,差异均无统计学意义(P>0.05);术后,观察组皮质醇、去甲肾上腺素为(183.28±16.85)、(273.42±24.23)μg/L,均低于对照组[(215.32±19.43)、(312.48±32.56)μg/L],差异均有统计学意义(P<0.05)。观察组结石清除率为95.00%,明显高于对照组(70.00%),差异有统计学意义(P<0.05)。观察组患者并发症发生率(7.50%)与对照组(2.50%)比较,差异无统计学意义(P>0.05)。结论mPCNL术中采用大功率钬激光联合负压清石鞘应用于上尿路结石治疗,创伤小、手术用时短,能够减轻肾功能损伤、氧化应激损伤,结石清除率高,安全可靠,可予以推广。

Objective To investigate the effect of high-power holmium laser combined with negative pressure stone removing sheath in microchannel percutaneous nephrolithotomy(mPCNL)in the treatment of upper urinary calculi.Methods Eighty patients with upper urinary calculi in the Second Affiliated Hospital of Chengdu Medical University·416 Hospital of Nuclear Industry from March 2017 to March 2021 were prospectively selected as the study subjects,and randomly divided into observation group(high-power holmium laser combined with negative pressure lithothecal sheath treatment)and control group(conventional mPCNL treatment),with 40 cases in each group.Operation indexes,renal function indexes before and after operation,oxidative stress indexes,stone clearance rate and complication rate of patients were compared between the two groups.Results The operation time,postoperative urine clearing and hospitalization time in the observation group were(75.29±7.74)min,(42.52±4.23)h,(8.12±1.24)d,which were shorter than those in the control group[(103.58±10.63)min,(134.22±14.23)h,(12.44±2.16)d],and the amount of intraoperative blood loss was(96.82±10.14)mL,which was less than that in the control group[(134.22±14.23)mL],the differences were statistically significant(P<0.05).There was no significant difference in preoperative creatinine and blood urea nitrogen levels between the two groups(P<0.05);after operation,the levels of creatinine and blood urea nitrogen in the observation group were(97.28±10.25)μmol/L,(6.01±0.35)μmol/L,which were lower than those in the control group[(104.82±11.53)μmol/L,(6.55±0.41)μmol/L],and the differences were statistical significance(P<0.05).Cortisol and norepinephrine were not significantly different between 2 groups before operation(P>0.05);After operation,the levels of cortisol and norepinephrine in the observation group were(183.28±16.85),(273.42±24.23)μg/L,which were lower than those in the control group[(215.32±19.43),(312.48±32.56)μg/L],and the differences were statistical significance(P<0.05).The calculi clearance rate in the observation group(95.00%)was significantly higher than that in the control group(70.00%),and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of complications between the observation group(7.50%)and the control group(2.50%)(P<0.05).Conclusion The application of high-power holmium laser combined with negative pressure lithiasis in the treatment of upper urinary tract calculi during mPCNL is safe and reliable,with little trauma and short operation time.It can reduce renal function injury and oxidative stress injury,and has a high stone clearance rate.Therefore,it can be popularized.