球囊与筋膜扩张器在输尿管镜钬激光碎石术结合物理振动排石治疗复杂性上尿路结石的应用价值

Application value of balloon and fascia dilator in ureteroscopic holmium laser lithotripsy combined with physical vibration in the treatment of complex upper urinary calculi

目的探讨球囊与筋膜扩张器在输尿管镜钬激光碎石术结合物理振动排石治疗复杂性上尿路结石的应用价值。方法选取2019年1月至2021年1月本院收治的98例复杂性上尿路结石患者作为研究对象,按术中使用不同扩张器分为观察组(n=51)和对照组(n=47)。观察组接受球囊扩张器下输尿管镜钬激光碎石术结合物理振动排石治疗,对照组接受筋膜扩张器下输尿管镜钬激光碎石术结合物理振动排石治疗,比较两组结石清除率、应激指标、炎症因子水平、并发症发生情况及复发情况。结果观察组结石清除率为94.12%,明显高于对照组的80.85%,差异有统计学意义(P<0.05)。术后,两组皮质醇(Cor)、去甲肾上腺素(NE)、肾上腺素(E)水平均高于术前,但观察组低于对照组,差异有统计学意义(P<0.05)。术后,两组白细胞介素-2(IL-2)水平均低于术前,白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均高于术前,且观察组IL-2水平高于对照组,IL-6、TNF-α水平均低于对照组,差异有统计学意义(P<0.05)。两组并发症发生率比较差异无统计学意义;观察组复发率低于对照组,差异有统计学意义(P<0.05)。结论球囊与筋膜扩张器在输尿管镜钬激光碎石术结合物理振动排石治疗复杂性上尿路结石中均有一定效果,但球囊扩张器结石清除率更高,可明显减轻应激与炎症反应,且术后复发率低。

Objective To investigate the application value of balloon and fascia dilator in ureteroscopic holmium laser lithotripsy combined with physical vibration in the treatment of complex upper urinary calculi.Methods 98 patients with complicated upper urinary tract calculi admitted to our hospital from January 2019 to January 2021 were selected as the research subjects,and they were divided into observation group(n=51)and control group(n=47)according to different intraoperative dilators.The observation group received ureteroscopic holmium laser lithotripsy under balloon dilator combined with physical vibration,and the control group received ureteroscopic holmium laser lithotripsy under fascia dilator combined with physical vibration,the calculi clearance rate,stress index,inflammatory factor level,complication occurrence and recurrence were compared between the two groups.Results The stone clearance rate of the observation group was 94.12%,which was significantly higher than 80.85%of the control group,and the difference was statistically significant(P<0.05).After surgery,the levels of cortisol(Cor),norepinephrine(NE)and epinephrine(E)in the two groups were higher than before surgery,and the observation group was lower than the control group,the difference was statistically significant(P<0.05).After surgery,the levels of interleukin-2(IL-2)in the two groups were lower than before surgery,and the levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were higher than before surgery,and the levels of IL-2 in observation group were higher than control group,while the levels of IL-6 and TNF-α were lower than control group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of complications between the two groups;the recurrence rate of the observation group was lower than that of the control group,and the difference was statistically significant(P<0.05).Conclusion Both balloon and fascia expander have the certain effect on ureteroscopic holmium laser lithotripsy combined with physical vibration in the treatment of complex upper urinary calculi,but the balloon expander has the higher stone clearance rate,significantly reduces stress and inflammatory response,and has lower postoperative recurrence rate.