输尿管软镜与微造瘘经皮肾镜下钬激光碎石术治疗2~3 cm肾下盏结石的临床效果

Clinical Effect of Holmium Laser Lithotripsy under Flexible Ureteroscopic and Microfistulation Percutaneous Nephroscope in the Treatment of 2-3 cm Lower Calyceal Calculus

目的:观察输尿管软镜(FU)与微造瘘经皮肾镜下钬激光碎石术(MPNHLL)治疗2~3 cm肾下盏结石的临床效果。方法:选取2020年1月─2022年1月清流县总医院收治的106例2~3 cm肾下盏结石患者为研究对象。采用随机数表法将其分为观察组和对照组,各53例。对照组采取MPNHLL治疗,观察组采取输尿管软镜钬激光碎石术(FUHLL)治疗。比较两组结石清除率、手术相关指标、术后并发症发生率,比较两组手术前后血清炎症指标及应激反应指标。结果:观察组结石清除率为96.23%,明显高于对照组的83.02%,差异有统计学意义(P<0.05)。观察组手术时间、住院时间明显短于对照组,术中出血量、血红蛋白(Hb)下降值明显少于对照组,差异有统计学意义(P<0.05)。术前,两组尿素氮(BUN)、血肌酐(Scr)、降钙素原(PCT)、β_(2)-微球蛋白(β_(2)-MG)水平比较,差异无统计学意义(P>0.05);术后3 d,观察组BUN、Scr、PCT、β_(2)-MG水平均低于对照组,差异有统计学意义(P<0.05)。观察组术后并发症发生率5.66%,略低于对照组的9.43%,但差异无统计学意义(P>0.05)。结论:FUHLL与MPNHLL均是高效且安全的碎石方式,两组术后并发症无明显差异,但FUHLL结石清除率较高,手术时间相对较短,对组织损伤较小,术中出血量较少。

Objective:To observe the clinical effect of flexible ureteroscopic(FU)and microfistulation percutaneous nephroscope holmium laser lithotripsy(MPNHLL)in the treatment of 2-3 cm lower calyceal calculus.Method:A total of 106 patients with 2-3 cm lower calyceal calculus treated in Qingliu County General Hospital from January 2020 to January 2022 were selected as the study objects.They were divided into observation group and control group by random number table method,53 cases in each group.The control group was treated with MPNHLL,and the observation group was treated with flexible ureteroscopic holmium laser lithotripsy(FUHLL).The stone clearance rate,operation-related indexes and postoperative complication rate were compared between the two groups.Serum inflammatory indexes and stress response indexes were compared between the two groups before and after operation.Result:The stone clearance rate of observation group was 96.23%,which was significantly higher than 83.02%of control group,the difference was statistically significant(P<0.05).The operation time and hospital stay in the observation group were significantly shorter than those in the control group,and the intraoperative blood loss and hemoglobin(Hb)decreased were significantly less than those in the control group,the differences were statistically significant(P<0.05).Before operation,there were no significant differences in the levels of blood urea nitrogen(BUN),serum creatinine(Scr),procalcitonin(PCT)andβ_(2)-microglobulin(β_(2)-MG)between two groups(P>0.05).At 3 d after operation,BUN,Scr,PCT andβ_(2)-MG levels in observation group were lower than those in control group,and the differences were statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 5.66%,slightly lower than 9.43%in the control group,but the difference was not statistically significant(P>0.05).Conclusion:Both FUHLL and MPNHLL are efficient and safe lithotripsy methods,and there is no significant difference in postoperative complications between the two groups,but FUHLL has a high stone clearance rate,relatively short operation time,less tissue damage and less intraoperative blood loss.