输尿管软镜下钬激光碎石术治疗直径≤3 cm肾结石的有效性与安全性评价

Efficacy and safety of flexible ureteroscopic holmium laser lithotripsy in the treatment of kidney stones with diameter≤3 cm

目的评价输尿管软镜下钬激光碎石术治疗直径≤3 cm肾结石的有效性与安全性。方法回顾性选取2019年2月至2022年2月秦皇岛市第二医院收治的直径≤3 cm肾结石患者100例,依据手术方法不同分为输尿管软镜下钬激光碎石术组(输尿管软镜组)和经皮肾镜组碎石术组(经皮肾镜组)两组,各50例。统计分析两组一次结石清除情况、围手术期指标、疼痛程度、血常规指标、血清炎症因子水平、肾功能指标、生活质量、术后并发症发生情况。结果输尿管软镜组的一次结石清除率(98.00%)与经皮肾镜组(90.00%)相比,差异无统计学意义(P>0.05)。输尿管软镜组术中出血量为(8.92±1.27)mL,明显少于经皮肾镜组[(49.37±7.23)mL],手术时间为(62.36±10.47)min,明显长于经皮肾镜组[(45.61±7.33)min],术后数字分级评分法(NRS)评分为(2.12±0.34)分,明显低于经皮肾镜组[(6.68±1.25)分],差异均有统计学意义(P<0.05),但两组患者的术后住院时间比较,差异无统计学意义(P>0.05)。输尿管软镜组患者的血红蛋白、SF-36评分(110.13±7.96)g/L、(92.32±5.46)分,明显均高于经皮肾镜组[(102.42±6.17)g/L、(80.12±9.36)分],C反应蛋白、白细胞介素-6、白细胞介素-10、胱抑素C、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)水平为(14.22±3.13)mg/L、(14.25±3.46)pg/mL、(7.27±1.34)pg/mL、(1.70±0.20)mg/L、(4.91±1.27)μg/L,均明显低于经皮肾镜组[(23.46±3.13)mg/L、(21.48±3.33)pg/mL、(9.57±1.53)pg/mL、(2.34±0.27)mg/L、(6.74±1.35)μg/L],差异均有统计学意义(P<0.05),但两组患者的白细胞计数、血肌酐、尿素氮水平比较,差异均无统计学意义(P>0.05)。输尿管软镜组患者的术后并发症发生率为2.00%,明显低于经皮肾镜组(16.00%),差异有统计学意义(P<0.05)。结论输尿管软镜下钬激光碎石术治疗直径≤3 cm肾结石的安全性较经皮肾镜组碎石术高,有效性与经皮肾镜组碎石术相当。

Objective To evaluate the efficacy and safety of flexible ureteroscopic holmium laser lithotripsy in the treatment of kidney stones with diameter≤3 cm.Methods A total of 100 patients with kidney stones≤3 cm in diameter in the Second Hospital of Qinhuangdao from February 2019 to February 2022 were retrospectively selected and divided into flexible ureteroscopy Holmium laser lithotripsy group(flexible ureteroscopy group)and percutaneous nephrolithotripsy group(percutaneous nephrolithotomy group)according to surgical methods,50 cases in each group.The stone clearance,perioperative indicators,pain degree,blood routine indicators,serum levels of inflammatory factors,renal function indicators,quality of life,and postoperative complications were statistically analyzed.Results There was no statistically significant difference in the primary stone clearance rate between flexible ureteroscopy group and percutaneous nephroscopy group(98.00%vs.90.00%)(P>0.05).The operation time of the flexible ureteroscopy group was longer than that of the percutaneous nephroscopy group,the intraoperative blood loss was less than that of the percutaneous nephroscopy group,and the postoperative numerical rating scale(NRS)score was lower than that of the percutaneous nephroscopy group(P<0.05).However,there was no statistically significant difference in the postoperative hospital stay between the two groups(P>0.05).Hemoglobin,SF-36 scores in the flexible ureteroscopy group were(110.13±7.96)g/L,(92.32±5.46)pionts,which were significantly higher than those in the percutaneous nephroscopy group[(102.42±6.17)g/L,(80.12±9.36)pionts],and the levels of C-reactive protein,interleukin-6,interleukin-10,cystatin C,neutrophil gelatinase related lipid transporter(NGAL)were(14.22±3.13)mg/L,(14.25±3.46)pg/mL,(7.27±1.34)pg/mL,(1.70±0.20)mg/L,(4.91±1.27)μg/L,which were significantly lower than those in the percutaneous nephroscopy group[(23.46±3.13)mg/L,(21.48±3.33)pg/mL,(9.57±1.53)pg/mL,(2.34±0.27)mg/L,(6.74±1.35)μg/L],the differences were statistically significant(P<0.05),but there were no statistically significant differences in the levels of WBC,SCr and BUN between the two groups(P>0.05).The postoperative complication rate of flexible ureteroscopy group was 2.00%,which was lower than that of percutaneous nephroscopy group(16.00%),the difference was statistically significant(P<0.05).Conclusion Flexible ureteroscopic Holmium laser lithotripsy is more safe and effective than percutaneous nephrolithotripsy in the treatment of kidney stones with diameter≤3 cm.