输尿管软镜下钬激光碎石术与经皮肾镜取石术治疗肾结石患者的效果

Comparison the effect of holmium laser lithotripsy and percutaneous nephrolithotomy under ureteroscope in the treatment of renal calculi

目的探究输尿管软镜下钬激光碎石术与经皮肾镜取石术治疗肾结石患者的效果。方法选取2021年2月至2022年3月抚州市立医院和抚州玉铭第八医院收治的52例肾结石患者作为研究对象,随机分为实验组与对照组,每组26例。实验组采用输尿管软镜下钬激光碎石术治疗,对照组采用经皮肾镜取石术治疗。比较两组围手术期指标、术后并发症发生情况、手术前后血清生化指标[尿素氮(BUN)、肌酐(Cr)、β2-微球蛋白(β2-MG)]、肾血流动力学[血流速度(V)、阻力指数(RI)、收缩期峰值与舒张期流速的比值(S/D)]及术后疼痛程度[视觉模拟评分法(VAS)]。结果实验组手术时间长于对照组,术中出血量少于对照组,住院时间短于对照组,差异有统计学意义(P<0.05);两组结石清除率比较差异无统计学意义。实验组并发症发生率低于对照组,差异有统计学意义(P<0.05)。术后,两组BUN、Cr、β2-MG水平均低于术前,且实验组低于对照组,差异有统计学意义(P<0.05)。术后,两组肾主动脉、段间动脉及叶间动脉V均慢于术前,两组段间动脉、叶间动脉及对照组肾主动脉RI均高于术前,实验组肾主动脉RI低于术前,两组肾主动脉、段间动脉及叶间动脉S/D均低于术前,且实验组肾主动脉、段间动脉及叶间动脉V快于对照组,肾主动脉、段间动脉及叶间动脉RI低于对照组,差异有统计学意义(P<0.05),两组肾主动脉、段间动脉及叶间动脉S/D比较差异无统计学意义。术后6、24h,实验组VAS评分均低于对照组,且两组术后24hVAS评分均低于术后6h,差异有统计学意义(P<0.05)。结论输尿管软镜下钬激光碎石术与经皮肾镜取石术均具有较高的结石清除率,但输尿管软镜下钬激光碎石术的并发症少、安全性高,可促进患者预后恢复,对肾功能具有保护作用。

Objective To investigate the effect of holmium laser lithotripsy and percutaneous nephrolithotomy under ureteroscope in the treat-ment of renal calculi.Methods 52 patients with renal calculi who were treated in Fuzhou Municipal Hospital and Fuzhou Yuming Eighth Hospital from February 2021 to March 2022 were selected as the research subjects,and they were randomly divided into the experimental group and the control group,with 26 cases in each group.The experimental group was treated with holmium laser lithotripsy under ureteroscope,while the control group were treated with percutaneous nephrolithotomy.The perioperative indexes,postoperative complications,serum biochemical indexes(blood urea ni-trogen[BUN],creatinine[Cr],β2-microglobulin[β2-MG]),renal hemodynamics(ratio of blood flow velocity[V],resistance index[RI],systolic veloci-ty/diastolic velocity[S/D])and postoperative pain degree(visual analogue scale[VAS])were compared between the two groups.Results The opera-tion time in the experimental group was longer than that in the control group,the intraoperative blood loss was less than that in the control group,and the hospital stay was shorter than that in the control group,the differences were statistically significant(P<0.05).There was no significant difference in stone clearance rate between the two groups.The complication rate in the experimental group was lower than that in the control group,and the differ-ence was statistically significant(P<0.05).After operation,BUN,Cr andβ2-MG levels of the two groups were lower than those before operation,and the experimental group was lower than the control group,the differences were statistically significant(P<0.05).After operation,the renal aorta,inter-segmental artery and interlobar artery V of the two groups were slower than those before operation,RI of intersegmental artery and interlobar artery of the two groups and renal aorta in control group were higher than before operation,the renal aorta RI in the experimental group was lower than that be-fore operation,and the renal aorta,intersegsegal artery and interlobar artery S/D of the two groups were lower than before operation,and the renal aorta,intersegsegal artery and interlobar artery V in the experimental group were faster than those in the control group,the renal aorta,intersegmental artery and interlobar artery RI were lower than those in the control group,the differences were statistically significant(P<0.05);there were no statistically sig-nificant differences in the renal aorta,intersegmental artery and interlobar artery S/D between the the two groups after operation.At 6 and 24 h after op-eration,the VAS scores in the experimental group were lower than those in the control group,and the VAS scores at 24 h after operation were lower than those at 6 h after operation,the differences were statistically significant(P<0.05).Conclusion Holmium laser lithotripsy under ureteroscope and per-cutaneous nephrolithotomy have high stone clearance rates,but holmium laser lithotripsy under ureteroscope has few complications and high safety,which can promote prognosis and protect renal function.