可弯曲负压吸引鞘联合输尿管软镜钬激光碎石术治疗直径2~3 cm上尿路结石的临床研究

Study on the treatment of upper urinary tract stones 2-3 cm in diameter using a flexible negative pressure suction sheath combined with flexible ureterorenoscopy holmium lithotripsy

目的 探索将可弯曲负压吸引鞘与输尿管软镜钬激光碎石术(FURL)相结合用于治疗直径2~3 cm上尿路结石的临床效果和安全性,以期拓展FURL的适用范围。方法 选择2019年3月—2022年9月浦江县人民医院收治的168例上尿路结石(直径2~3 cm)患者为研究对象,采用随机数字表法分为研究组(84例)和对照组(84例),研究组实施可弯曲负压吸引鞘联合FURL,对照组实施经皮肾镜取石术(PCNL)。记录患者手术指标,统计结石清除率,检测手术前后血清炎症因子、应激反应因子和肾功能指标水平,随访术后并发症情况。结果 研究组手术时长、尿液转清时间、首次下床时间和住院时间[(64.75±5.62) min、(2.53±0.36)d、(1.81±0.32)d、(7.25±0.86)d]均短于对照组[(73.84±5.93)min、(3.29±0.41)d、(2.47±0.39)d、(9.48±1.07)d,均P<0.05]。2组结石清除率[94.05%(79/84)vs.97.62%(82/84)]差异无统计学意义(P>0.05)。研究组术后3d血清炎症因子[肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)]、应激反应因子[去甲肾上腺素(NE)和皮质醇(Cor)]和肾功能指标[尿素氮(BUN)、血肌酐(SCr)、尿酸(UA)、胱抑素C(Cys-C)]均低于对照组(均P<0.05)。研究组术后并发症总体发生率低于对照组(P<0.05)。结论 可弯曲负压吸引鞘联合FURL用于治疗直径2~3 cm的上尿路结石,在有效清除结石的基础上,可以缩短手术时间,促进患者术后快速康复,减少医源性创伤,缓解炎症及应激反应,减少术后并发症。

Objective To observe the clinical efficacy and safety of flexible negative pressure ureteral access sheath combined with flexible ureterorenoscopy holmium lithotripsy(FURL)for upper urinary tract calculi.Methods A total of 168 patients with upper urinary tract calculi(2 to 3 cm in diameter),who admitted to Pujiang People's Hospital from March 2019 to September 2022,were selected as the research objects.They were divided into study group(84 cases)and control group(84 cases)by random number table method.The study group was treated with flexible negative pressure suction sheath combined with FURL,and the control group was treated with percutaneous holmium laser nephrolithotomy(PCNL).The operation duration,urine clearance time,first time out of bed,hospital stay and other surgical indicators were recorded,and the stone clearance rate was calculated,the levels of serum inflammatory factor,stress response factors and renal function index content were determined before and after operation,and the postoperative complications were observed.Results The study group had significantly shorter operative duration,urine clearance time,first time out of bed,and hospitalization time[(64.75±5.62)min,(2.53±0.36)d,(1.81±0.32)d,(7.25±0.86)d]compared to the control group[(73.84±5.93)min,(3.29±0.41)d,(2.47±0.39)d,(9.48±1.07)d,all P<0.05].There was no significant difference in stone clearance rate between the two groups[94.05%(79/84)vs.97.62%(82/84),P>0.05].The levels of inflammatory factors[tumor necrosis factor-α(TNF-α),hypersensitive Creactive protein(hs-CRP),IL-6 and IL-8],stress response factors[norepinephrine(NE),cortisol(Cor)]J and renal function indicators[serum creatinine(SCr),blood urea nitrogen(BUN),uric acid(UA)and cystatin C(Cys-C)]were significantly lower than the control group 3 days after operation(all P<0.05).The overall incidence of postoperative complications was significantly lower in the study group than that in the control group(P<0.05).Conclusion The flexible negative pressure suction sheath combined with FURL can be used to treat upper urinary tract calculi with a diameter of 2-3 cm.On the basis of ensuring the effectiveness of stone removal,it can shorten the operation time,promote the rapid recovery of patients after operation,reduce iatrogenic trauma,reduce the degree of inflammation and stress reaction of patients,reduce postoperative complications.