基于低压灌注引流的输尿管镜激光碎石对输尿管结石患者疗效及肾功能标志物的影响研究

Curative Effect of Ureteroscopic Laser Lithotripsy Under Low Pressure Perfusion on Patients with Ureteral Calculi and Their Renal Function Markers

目的 研究经低压灌注引流的输尿管镜激光碎石对输尿管结石患者的临床疗效和肾功能标志物的影响。方法 选取2018年8月至2020年12月,输尿管结石患者154例,均行经输尿管镜激光碎石治疗。154例患者根据灌注引流方式不同,分为低压灌注组患者74例和普通灌注组患者80例。激光碎石功率60 W,频率20~30 Hz,能量0.8~1.0 J。记录两组患者的手术时间,术后3 d的结石残留率和并发症发生率。同时,记录术后3 d患者肾功能、炎症因子的改变。结果 治疗后3 d低压灌注组的清石率(97.4%)高于普通灌注组(88.8%)(P<0.05)。治疗后3 d两组患者的血肌酐、血尿素均明显降低,而明胶酶相关脂质运载蛋白水平均明显增加,其中低压灌注组的肾功能指标水平均优于普通灌注组(P<0.05)。治疗后3d两组患者的肿瘤坏死因子-α、C反应蛋白水平均明显升高,其中低压灌注组的炎症因子水平均明显低于普通灌注组(P<0.05)。两组患者并发症主要为感染、肾区疼痛、血尿、全身炎症反应综合征,低压灌注组并发症发生率(10.8%)低于普通灌注组(23.8%)(P<0.05)。结论 在输尿管镜钬激光碎石术中采取低压灌注引流可降低肾损伤风险,提高结石清除率,降低并发症风险,具有良好的临床价值。

Objective To investigate the effect of ureteroscopic laser lithotripsy under low-pressure perfusion drainage on the clinical efficacy and renal function markers of patients with ureteral calculi.Methods Totally 154 patients with ureteral calculi,given ureteroscopic laser lithotripsy during the period from Aug.2018 to Dec.2020 were selected and divided into a low-pressure perfusion group(74 cases) and an ordinary perfusion group(80 cases) by perfusion and drainage methods.The laser stone crushing power used in the treatment was 60 W,the frequency 20~30 Hz,and the energy 0.8~1.0 J.The operation time,3-day postoperative stone residual rate and complication rate of the two groups were recorded respectively.At the same time,the changes of renal function and inflammatory factors were recorded 3 days after the operation.Results Three days after the treatment,the stone removal rate(97.4%) of the low-pressure perfusion group was higher than that(88.8%) of the ordinary perfusion group(P<0.05).Moreover,for both groups,the levels of serum creatinine and blood urea decreased significantly while the levels of gelatinase related lipid carrier protein increasing dramatically.The levels of renal function indexes in the low-pressure perfusion group were higher than those in the ordinary perfusion group(P<0.05).The serum tumor necrosis factor-α and C-reactive protein levels increased significantly,and the levels of inflammatory factors in the low-pressure perfusion group were much lower than those in the normal perfusion group(P<0.05).The main complications occurred in both groups included infection,renal pain,hematuria and systemic inflammatory response syndrome.The incidence of complications in the lowpressure perfusion group(10.8%) was lower than that(23.8%) in the ordinary perfusion group(P<0.05).Conclusions Low pressure perfusion and drainage in ureteroscopic holmium laser lithotripsy will improve stone removal rate while reducing renal injury and adverse complications.