经输尿管软硬镜钬激光碎石术治疗上尿路结石的疗效及其对患者肾功能和术后炎症指标的影响

Efficacy of ureteroscopic holmium laser lithotripsy in the treatment of upper urinary tract calculi and its effect on renal function and postoperative inflammatory indicators

目的探讨输尿管软镜联合输尿管硬镜钬激光碎石术治疗对上尿路结石的疗效及其对术后炎症指标的影响。方法回顾性分析2020年7月至2022年6月百色市人民医院泌尿外科收治的120例上尿路结石患者的临床资料。按照随机数字表法将患者分为对照组和观察组,每组各60例。对照组采用输尿管硬镜钬激光碎石术,观察组在对照组输尿管硬镜的基础上联合使用输尿管软镜钬激光碎石。比较两组手术相关指标(手术时间、术中出血量、术后住院时间及手术费用)、清石效果(一次性碎石成功率、结石排净率及复发率)、术前术后肾功能指标(血尿素氮、血清肌酐及胱抑素C)及炎症指标[白细胞介素-6(IL-6)、C反应蛋白(CRP)、降钙素原(PCT)]的变化,并比较术后2周并发症发生率。结果两组术中出血量及术后住院时间比较,差异均无统计学意义(P>0.05);观察组手术时间为(76.15±12.37)min,短于对照组[(88.72±10.68)min],手术费用为(11263.18±742.18)元,高于对照组[(5769.45±647.96)元],差异均有统计学意义(P<0.05)。观察组一次碎石成功率及结石取净率分别为90.00%、96.67%,均高于对照组(75.00%、85.00%),术后复发率为3.33%,低于对照组(16.67%),差异均有统计学意义(P<0.05)。术后,两组血尿素氮、血清肌酐及胱抑素C均较术前升高,但观察组分别为(10.84±2.06)mmol/L、(71.72±15.42)μmol/L、(563.42±72.16)μg/L,均低于对照组[(12.36±2.32)mmol/L、(76.48±17.41)μmol/L、(672.71±77.94)μg/L],差异均有统计学意义(P<0.05)。术后,两组CRP、PCT及IL-6均较术前降低,且观察组分别为(4.67±1.29)mg/L、(0.26±0.07)ng/mL、(6.15±1.39)pg/mL,均低于对照组[(5.48±1.54)mg/L、(0.32±0.09)ng/mL、(8.23±1.74)pg/mL],差异均有统计学意义(P<0.05)。观察组总并发症发生率为5.01%,低于对照组(18.34%),差异有统计学意义(P<0.05)。结论输尿管软镜联合输尿管硬镜钬激光碎石术治疗上尿路结石的清石效果较好,且其对肾功能影响小,炎症反应低,术后复发率低。

Objective To investigate the effect of flexible ureteroscopy combined with ureteroscopic holmium laser lithotripsy on upper urinary tract calculi and its influence on postoperative inflammatory markers.Methods The clinical data of 120 patients with upper urinary tract stones admitted to Department of Urology,Baise People's Hospital from July 2020 to June 2022 were analyzed retrospectively.According to the random number table,patients were divided into the control group and the observation group,with 60 cases in each group.The control group was treated with ureteroscopic holmium laser lithotripsy,and the observation group was treated with flexible ureteroscopic holmium laser lithotripsy on the basis of the control group.The operation related indexes(operation time,intraoperative blood loss,postoperative hospital stay and operation cost),stone clearance effect(one-time lithotripsy success rate,stone clearance rate and recurrence rate),preoperative and postoperative renal function indexes(blood urea nitrogen,serum creatinine and Cystatin C)and inflammatory indexes[interleukin-6(IL-6),C-reactive protein(CRP),procalcitonin(PCT)]were compared between the two groups,and the incidence of complications at 2 weeks after operation was compared.Results There was no statistically significant difference in intraoperative bleeding volume and postoperative hospital stay between the two groups(P>0.05);the surgical time of the observation group was(76.15±12.37)minutes,which was shorter than that of the control group[(88.72±10.68)minutes],and the surgical cost was(11263.18±742.18)yuan,which was higher than that of the control group[(5769.45±647.96)yuan],the differences were statistically significant(P<0.05).The success rate and stone removal rate of the observation group were 90.00% and 96.67%,respectively,which were higher than those of the control group(75.00% and 85.00%),the postoperative recurrence rate was 3.33%,which was lower than that of the control group(16.67%),and the differences were statistically significant(P<0.05).After operation,the levels of blood Blood urea nitrogen,serum creatinine and Cystatin C in two groups were higher than those before operation,but those in the observation group were(10.84±2.06)mmol/L,(71.72±15.42)μmol/L,(563.42±72.16)μg/L,respectively,which were lower than those in the control group[(12.36±2.32)mmol/L,(76.48±17.41)μmol/L,(672.71±77.94)μg/L],the differences were statistically significant(P<0.05).After operation,the levels of CRP,PCT,and IL-6 in two groups were lower than those before operation,and the observation group was(4.67±1.29)mg/L,(0.26±0.07)ng/mL,and(6.15±1.39)pg/mL,respectively,which were lower than those in the control group[(5.48±1.54)mg/L,(0.32±0.09)ng/mL,and(8.23±1.74)pg/mL],the differences were statistically significant(P<0.05).The incidence of total complications in the observation group was 5.01%,which was lower than that in the control group(18.34%),the difference was statistically significant(P<0.05).Conclusion Flexible ureteroscopy combined with ureteroscopic holmium laser lithotripsy is effective in the treatment of upper urinary tract calculi,with little effect on renal function,low inflammatory response and low recurrence rate.