经尿道输尿管软镜钬激光碎石术对肾及上段输尿管结石患者排石效果及肾功能的影响

Effect of Transurethral Flexible Ureteroscopy Holmium Laser Lithotripsy on Stone Removal and Renal Function in Patients with Renal and Upper Ureteral Calculi

目的探究经尿道输尿管软镜钬激光碎石术(FURS)对肾及上段输尿管结石患者排石效果及肾功能的影响。方法研究数据源于2021年9月-2023年10月内本院收治的84例肾及上段输尿管结石患者病历资料。所有患者进行经尿道FURS治疗。观察治疗后的排石效果、术中及术后情况、肾功能损害相关指标及并发症。结果术后半月结石清除例数为62例,清除率为(62/84)73.81%;术后1月结石清除例数为71例,清除率为(71/84)84.52%。所有患者手术时间为40min~100min,平均手术时间(76.85±10.85)min。全部病例软镜鞘的置鞘成功率为(84/84)100%。本组84例患者中仅2例为铸型结石,实施二次碎石后取净,其他患者均一次碎石成功。84例患者中33例输尿管上段结石均一次取净结石。患者住院时间为4~6d,平均住院时间(4.24±0.55)d。与治疗前相比,经尿道FURS治疗12h后患者的肌酐、尿素氮、Cys-C水平均升高,差异显著(P<0.05),与治疗后12h相比,治疗后72h各指标水平均降低,差异显著(P<0.05)。经尿道FURS治疗后,术后2例患者发热,经过对症处理后均明显好转,并发症总发生率为2.38%,无其他并发症。结论经尿道FURS对肾及上段输尿管结石患者有良好的排石效果,对患者肾功能损伤较小,并发症少,安全有效。

Objective To investigate the effect of transurethral flexible ureteral holmium laser lithotripsy(FURS)on stone removal and renal function in patients with renal and upper ureteral calculi.Methods The study data were derived from the medical records of 84 patients with renal and upper ureteral calculi admitted to our hospital from September 2021 to October 2023.All patients were treated with transurethral FURS.The effects of stone removal,intraoperative and postoperative conditions,renal function impairment and complications were observed.Results The number of postoperative semilunar stone removal cases was 62,the clearance rate was(62/84)73.81%.There were 71 cases of stone removal 1 month after operation,and the clearance rate was 84.52%(71/84).The operation time of all patients was 40min~100min,and the average operation time was(76.85±10.85)min.The success rate of soft lens sheath placement in all cases was(84/84)100%.In this group of 84 patients,only 2 cases were cast stones,which were removed after secondary lithotripsy,and other patients were successfully lithotripsy once.Of the 84 patients,33 had the upper ureteral calculi removed once.The length of hospital stay was 4~6 days,and the average length of hospital stay was(4.24±0.55)days.Compared with before treatment,the levels of creatinine,urea nitrogen and Cys-C were increased after 12h of tranthral FURS treatment,and the differences were significant(P<0.05),while the levels of all indexes were decreased after 72h compared with 12h after treatment,and the differences were significant(P<0.05).After transurethral FURS treatment,2 patients had fever after operation,and after symptomatic treatment,all of them were significantly improved,the total complication rate was 2.38%,and no other complications were found.Conclusion Transurethral FURS is safe and effective in treating patients with renal and upper ureteral calculi with less damage to renal function and fewer complications.