7.5 Fr电子输尿管软镜治疗小负荷上尿路结石的临床观察

Clinical analysis of 7.5 Fr electronic flexible ureteroscopy for small upper urinary stones

目的探讨7.5 Fr一次性电子输尿管软镜治疗输尿管上段或肾内单发小负荷结石的有效性和安全性。方法回顾性分析2021年6月至2022年12月手术干预的输尿管上段或肾内单发结石患者400例,结石直径1 cm左右,按手术方式分为观察组和对照组,各200例,分别行7.5 Fr和8.5 Fr一次性电子输尿管软镜联合钬激光碎石取石术,术中分别置入9.5/11.5 Fr和12/14 Fr输尿管软镜鞘,钬激光碎石,套石篮取石。观察两组围术期指标、并发症情况、随访结果及手术前后白细胞计数、中性粒细胞比值、C反应蛋白等感染指标。结果观察组200例(100%)患者均一期置鞘完成手术,无分次手术干预或改行经皮肾镜激光碎石术。对照组151例(75.5%)一期置鞘完成手术,余49例中分次进行手术干预7例,改行经皮肾镜激光碎石术42例。两组患者术后复查X线示结石均清除,无残留。观察组术中出血量明显少于对照组,术后血尿持续时间、腰腹部疼痛持续时间及住院时间明显短于对照组,差异均有统计学意义(P<0.05);两组手术时间、置镜成功率及结石清除率比较均无统计学差异(P>0.05)。术后两组患者均不留置导尿管,无感染发生,未出现尿源性脓毒血症。术后观察组15例(7.5%)、对照组73例(36.5%)发生输尿管双J管留置相关并发症(腹痛、血尿或膀胱刺激征),两组比较无统计学差异(P>0.05)。两组手术前、后白细胞计数、中性粒细胞比值、C反应蛋白等感染指标比较均无统计学差异(P>0.05)。结论7.5 Fr一次性电子输尿管软镜治疗输尿管上段或肾内单发小负荷结石(直径1 cm左右)置镜成功率及结石清除率高,创伤小,患者恢复快,安全有效。

Objective To discuss the effect and safety of 7.5 Fr disposable electronic flexible ureteroscope in the treatment of single intrarenal stone or upper ureteral stone with diameter of 1 cm.Methods A total of 400 patients with single ureteral or renal stone,with an average diameter of 1 cm,who underwent surgical intervention from June 2021 to December 2022 were divided into the observation group and control group by surgical procedure,with 200 patients in each group,and treated by electronic ureteroscopy with 7.5 Fr and 8.5 Fr disposable flexible ureteroscope combined with holmium laser lithotripsy respectively.During the surgery,9.5/11.5 Fr and 12/14 Fr soft lens sheath were placed in the observation group and control group respectively,holmium laser lithotripsy was performed,and stone basket was applied to remove stones.The perioperative indexes,complications,follow-up results and infection indexes such as white blood cell(WBC)count,neutrophil ratio and C-reactive protein before and after operation were compared between the two groups.Results One-stage sheath placement was succeed in all 200 cases(100%)of the observation group,and was in 151 cases(75.5%)of the control group.Staged surgery was performed in 7 cases,and percutaneous nephroscopic laser lithotripsy was in 42 cases in the other 49 cases of the control group.Postoperative abdominal X-ray showed that stone-free were achieved without residual stones in both groups.The intra-operative blood loss volume was less,the duration of postoperative hematuria,the time of lumbar and abdominal pain and hospital stays were shorter in the observation group than those in the control group,and all differences were statistically significant(P<0.05).There was no statistical difference in operation time,success rate of ureteroscope placement and stone-free rate between the two groups(P>0.05).No urinary catheter was placed after surgery,and no infection or urinary sepsis was found in both groups.Postoperative complications(such as abdominal pain,hematuria or bladder irritation)associated with indwelling of ureteral double J tube occurred in 15 cases(7.5%)in the observation group and 73 cases(36.5%)in the control group.There was no significant difference in the incidence of complications and infection indexes(as WBC count,neutrophil ratio and C-reactive protein)between the two groups(P>0.05).Conclusion Flexible ureteroscopic lithotripsy with 7.5 Fr disposable electronic ureteroscope can achieve high success rate of ureteroscope placement and stone-free rate with mini-trauma,rapid recovery,and it is safe and effective for single renal stone or upper urinary stone with diameter of 1 cm.