组合式输尿管软镜碎石术与微通道经皮肾镜碎石术治疗输尿管上段结石的临床效果及安全性

Clinical Efficacy and Safety of Combined Flexible Ureteroscope Lithotripsy and Microchannel Percutaneous Nephrolithotomy in the Treatment of Upper Ureteral Calculi

目的:对比组合式输尿管软镜碎石术、微通道经皮肾镜碎石术对输尿管上段结石的治疗效果,探讨一种有效术式,以提高疗效,促进患者尽早康复。方法:选取张家港市第一人民医院泌尿外科2019年1月-2021年12月收治的86例输尿管上段结石患者,所有患者均进行手术治疗。根据不同术式将其分成对照组(微通道经皮肾镜碎石术)与研究组(组合式输尿管软镜碎石术),各43例。对比两组手术指标、术后疼痛程度(VAS评分)、肝肾功能、炎症因子水平、并发症发生情况、临床疗效、手术成功率与结石残留率。结果:研究组手术指标均优于对照组,术后6、12、24 h的VAS评分均低于对照组(P<0.05)。两组术前与术后1 d肝肾功能对比,差异均无统计学意义(P>0.05)。研究组术后1 d炎症因子水平及并发症发生率均低于对照组(P<0.05)。两组总有效率、手术成功率与结石残留率比较,差异均无统计学意义(P>0.05)。结论:组合式输尿管软镜治疗输尿管上段结石的应用效果理想,具有出血量少、疼痛轻微、恢复快等优势,且对患者炎症因子水平影响轻微,并发症少,可推行。

Objective:To compare the therapeutic effects of combined flexible ureteroscope lithotripsy and microchannel percutaneous nephrolithotripsy on upper ureteral calculi,and to explore an effective method to improve the curative effect and promote the early recovery of patients.Method:A total of 86 patients with upper ureteral calculi treated in the Department of Urology of Zhangjiagang First People’s Hospital from January 2019 to December 2021 were selected,all patients were treated with surgery.According to different surgical methods,they were divided into the control group (microchannel percutaneous nephrolithotripsy) and the study group (combined flexible ureteroscope lithotripsy),43 cases in each group.The surgical indexes,postoperative pain (VAS score),liver and kidney function,inflammatory factors levels,complications,clinical efficacy,surgical success rate and stone residue rate of two groups were compared.Result:The surgical indexes in the study group were better than those in the control group,and the VAS scores at 6,12,and 24 h after operation were lower than those in the control group (P<0.05).There were no significant differences in liver and kidney function between two groups before operation and 1 d after operation (P>0.05).The levels of inflammatory factors at 1 d after operation and the incidence of complications in the study group were lower than those in the control group (P<0.05).There were no significant differences in the total effective rate,surgical success rate and residual stone rate between two groups (P>0.05).Conclusion:The application effect of combined flexible ureteroscopic lithotripsy in the treatment of upper ureteral calculi is ideal,it has the advantages of less bleeding,mild pain and rapid recovery,and has a slight impact on the level of inflammatory factors and less complications,it can be implemented.