输尿管软镜碎石术治疗肾结石的效果

Efficacy of Flexible Ureteral Lithotripsy in the Treatment of Kidney Stones

目的探讨输尿管软镜碎石术(FURL)治疗肾结石的效果及对预后的影响。方法选取2021年3月至2022年3月新乡医学院第一附属医院收治的82例肾结石患者,随机分为两组,各41例。对照组接受经皮肾镜碎石术(PCNL)治疗,研究组接受FURL治疗。观察两组手术与术后康复情况、清石效果、免疫-应激因子[T淋巴细胞(CD4^(+))、CD4^(+)/CD8^(+)、去甲肾上腺素(NE)、血管紧张素Ⅰ(AngⅠ)]、血流动力学[阻力指数(RI)、舒张末期流速(Vmin)、收缩期峰值流速(Vmax)]、并发症发生率、治疗成本、术后随访的1 a复发率。结果研究组手术时间长于对照组,术中出血量、术后下床时间与住院时间较对照组少,结石一次清除率较对照组高(P<0.05);研究组术后1、3 d血清CD4^(+)、CD4^(+)/CD8^(+)高于对照组,NE、AngⅠ水平低于对照组(P<0.05);研究组术后1、3 d肾脏段Vmax、Vmin高于对照组,RI低于对照组(P<0.05);研究组直接成本、总治疗成本低于对照组(P<0.05);两组并发症发生率、复发率比较,差异无统计学意义(P>0.05)。结论FURL治疗肾结石患者能提高清石效果,降低创伤应激对免疫功能的影响,同时减少术中出血量,有助于微循环恢复,促进病情恢复,降低治疗成本,且具有较好的安全性及远期效果,但会延长手术时间。

Objective To investigate the efficacy and prognosis of flexible ureteral lithotripsy(FURL)in the treatment of kidney stones.Methods A total of 82 patients with kidney stones in the First Affiliated Hospital of Xinxiang Medical University from March 2021 to March 2022 were randomly divided into two groups,with 41 cases in each group.The control group was treated with percutaneous nephrolithotripsis(PCNL),and the study group was treated with FURL.Operation and postoperative rehabilitation,stone-clearing effect,immune-stress factors[T lymphocytes(CD4^(+)),CD4^(+)/CD8^(+),norepinephrine(NE),angiotensinⅠ(AngⅠ)],hemodynamics[resistance index(RI),end diastolic velocity(V min),peak systolic velocity(V max)were observed in the two groups],complication rate,treatment cost,recurrence rate after 1 year of postoperative follow-up were statistically compared between the two groups.Results The operation time of the study group was longer than that of the control group,the amount of blood loss,the time of getting out of bed after operation and the number of days in hospital were less,and the primary stone clearance rate was higher than that of the control group(P<0.05).The levels of serum CD4^(+)and CD4^(+)/CD8^(+)in the study group were higher than those in the control group 1 and 3 days after surgery,and the levels of NE and AngⅠwere lower than those in the control group(P<0.05).The renal V max and V min of the study group were higher than those of the control group,and the RI of the study group was lower than that of the control group(P<0.05).The direct cost and total treatment cost in the study group were lower than those in the control group(P<0.05).There were no differences in complication rate and recurrence rate between the two groups(P>0.05).Conclusion FURL in the treatment of kidney stone patients can improve the effect of stone removal,reduce the impact of traumatic stress on immune function,reduce the amount of intraoperative blood loss,contribute to the recovery of microcirculation,promote the recovery of disease,reduce the cost of treatment,and have good safety and long-term effects,but can prolong the operation time.