两种灌注方法在输尿管软镜治疗上尿路结石中的对比研究

Comparative study of two perfusion methods in the treatment of upper urinary calculi by flexible ureteroscope

目的探讨灌注泵恒流灌注法和手推注射器灌注法在输尿管软镜治疗上尿路结石中的临床效果。方法回顾性分析2021年6月—2022年9月在本院行经尿道输尿管软镜钬激光碎石术的73例患者的临床资料,按灌注方式的不同分为观察组(恒流灌注组,38例)和对照组(手推注射器组,35例)两组。比较两组手术时间,术后6小时腰部胀痛情况(采用VAS视觉模拟评分法),术后肠道功能恢复时间,术后24小时炎症指标[降钙素原(PCT)、C反应蛋白(CRP)、血白细胞(WBC)],发热例数(体温>38.5度),结石清除率,以及术后并发症。结果两组手术时间、腰部胀痛情况差异有统计学意义(P<0.05),观察组手术时间短于对照组,而VAS评分高于对照组;两组肠道功能恢复时间比较,差异有统计学意义(P<0.05),观察组肠道功能恢复时间长于对照组;两组术后炎症指标比较,差异有统计学意义(P<0.05),观察组指标低于对照组;两组发热情况比较,差异无统计学意义(P>0.05);两组结石清除率比较,差异无统计学意义(P>0.05),效果均显著;两组手术并发症比较,差异无统计学意义(P>0.05),均安全可靠。结论严格把握手术指征,两种方法均安全有效,灌注泵恒流灌注法较手推灌注手术时间短,且更节省人力,而手推法术后腰部胀痛情况发生率更低,肠道功能恢复时间短,患者术后舒适度更好,两者各有优势。

Objective To investigate the clinical effect of constant flow perfusion pump and manual syringe perfusion in the treatment of upper urinary tract calculi with ureteroscope.Methods The clinical data of patients who underwent transurethral holmium laser lithotripsy under flexible ureteroscope in Wuwei people's hospital from June 2021 to September 2022 were analyzed retrospectively.According to the perfusion methods the patients were divided into observation group(constant flow perfusion group,n=38)and in the control group(manual injector group,n=35).The two groups were compared in terms of operation time,waist pain and distension at 6 hours after operation(using visual analog scoring method,VAS),intestinal function recovery time after operation,inflammatory indicators at 24 hours after operation[procalcitonin(PCT),C-reactive protein(CRP),white blood cells(WBC)],number of fever(body temperature over 38.5 degrees),stone clearance rate,and postoperative complications.Results There was a significant difference between the two groups in operation time and waist pain(P<0.05).The operation time of the observation group was shorter than that of the control group,while the VAS score was higher than that of the control group.The recovery time of intestinal function in the two groups was statistically different(P<0.05).The recovery time of intestinal function in the observation group was longer than that in the control group.There was a significant difference between the two groups in the postoperative inflammatory indexes,and the indexes in the observation group were lower than those in the control group(P>0.05).There was no significant difference in fever between the two groups(P>0.05).There was no significant difference in stone clearance between the two groups(P>0.05).There was no significant difference in surgical complications between the two groups(P>0.05),both methods were safe and reliable.Conclusions The two methods are safe and effective by strictly grasping the surgical indications.The constant flow perfusion method with perfusion pump is shorter in operation time than the hand push perfusion method,and saves more manpower.The hand push method has lower incidence of lumbar distension and pain,shorter recovery time of intestinal function,and better postoperative comfort.Generally,both methods have their advantages.