取石网篮与封堵器应用于经输尿管镜钬激光碎石术治疗输尿管上段结石的效果对比

Comparison of the Effects of Stone Basket and Occluder in the Treatment of Upper Ureteral Calculi by Ureteroscopic Holmium Laser Lithotripsy

目的:探讨取石网篮与封堵器应用于经输尿管镜钬激光碎石术(URL)治疗输尿管上段结石中的临床效果。方法:选取2021年4月—2023年4月东莞市横沥医院接诊的96例输尿管上段结石患者,根据随机数表法分为URL组、URL+封堵器组、URL+取石网篮组,各32例。其中URL组接受URL治疗,URL+封堵器组接受URL配合封堵器治疗,URL+取石网篮组接受URL配合取石网篮治疗。比较三组围手术期相关指标、结石清除效果、血清、尿液炎症水平、肾盂积水量,并记录术后并发症发生情况。结果:URL组住院时间长于URL+取石网篮组、URL+封堵器组,手术时间短于URL+取石网篮组、URL+封堵器组,结石清除率低于URL+取石网篮组、URL+封堵器组,结石逃逸率高于URL+取石网篮组、URL+封堵器组,差异有统计学意义(P<0.05)。术后3个月,URL组血清、尿液肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)、白细胞介素-6(IL-6)水平均高于URL+取石网篮组与URL+封堵器组,差异有统计学意义(P<0.05);术后3个月,URL组肾盂积水量高于URL+取石网篮组、URL+封堵器组,差异有统计学意义(P<0.05);URL组术后并发症总发生率高于URL+取石网篮组与URL+封堵器组,差异有统计学意义(P<0.05)。术后3个月,URL+取石网篮组与URL+封堵器组血清及尿液TNF-α、CRP、IL-6水平、肾盂积水量、术后并发症总发生率比较,差异无统计学意义(P>0.05)。结论:取石网篮与封堵器用于URL治疗输尿管上段结石临床效果相当,均能有效提升结石清除率,减轻炎症反应,降低肾盂积水量及并发症发生率。

Objective:To investigate the clinical effect of stone basket and occluder in the treatment of upper ureteral calculi by ureteroscopic holmium laser lithotripsy(URL).Method:A total of 96 patients with upper ureteral calculi admitted to Dongguan Hengli Hospital from April 2021 to April 2023 were selected,they were divided into URL group,URL+occluder group and URL+reticular basket group according to random number table method,with 32 cases in each group.The URL group received URL treatment,the URL+occluder group received URL combined with occluder treatment,and the URL+reticular basket group received URL combined with reticular basket treatment.Perioperative indexes,stone removal effect,serum and urine inflammation levels and renal pelvis water volume were compared between the three groups;the postoperative complications were recorded.Result:The hospital stay of the URL group was longer than that of the URL+reticular basket group and URL+occluder group,the operation time was shorter than that of the URL+reticular basket group and URL+occluder group,the stone clearance rate was lower than that of the URL+reticular basket group and URL+occluder group,and the stone escape rate was higher than that of the URL+reticular basket group and URL+occluder group,the differences were statistically significant(P<0.05).Three months after surgery,serum and urine tumor necrosis factor-α(TNF-α),C-reactive protein(CRP),and interleukin-6(IL-6)levels in URL group were higher than those in URL+reticular basket group and URL+occluder group,and the differences were statistically significant(P<0.05).Three months after surgery,the renal pelvis water volume in URL group was higher than that in URL+reticular basket group and URL+occluder group,and the difference was statistically significant(P<0.05).The total incidence of postoperative complications in URL group was higher than that in URL+reticular basket group and URL+occluder group,and the difference was statistically significant(P<0.05).Three month after surgery,there were no statistical differences in serum and urine TNF-α,CRP,IL-6,renal pelvis water volume and total incidence of postoperative complications between the URL+reticular basket group and the URL+occluder group(P>0.05).Conclusion:The clinical effect of reticular basket and occluder used in URL treatment of upper ureteral calculi is similar,both can effectively improve stone clearance rate,reduce inflammatory reaction,reduce renal pelvis water volume and complication rate.