输尿管软镜钬激光碎石术治疗输尿管上段结石患者的效果

Effects of flexible ureteroscopic Holmium laser lithotripsy in treatment of patients with upper ureteral calculi

目的:观察输尿管软镜钬激光碎石术治疗输尿管上段结石患者的效果。方法:选取2020年6月至2023年6月该院收治的92例输尿管上段结石患者进行前瞻性研究,按照随机数字表法将其分为研究组和对照组各46例。对照组采用经皮肾镜碎石术治疗,研究组采用输尿管软镜钬激光碎石术治疗,比较两组结石清除率,术后恢复时间,手术前后排尿功能指标[术后残余尿量(RUV)、最大尿流率、最大尿道压(MUP)]水平,术后氧化应激指标[肾上腺素(E)、皮质醇(Cor)]水平和并发症发生率。结果:研究组结石清除率为89.13%(41/46),高于对照组的71.74%(33/46),差异有统计学意义(P<0.05);研究组首次下床活动时间、手术时间和住院时间均短于对照组,差异有统计学意义(P<0.05);术后7 d,两组最大尿流率、MUP水平均高于术前,且研究组高于对照组,两组RUV均低于术前,且研究组低于对照组,差异有统计学意义(P<0.05);术后7 d,两组E、Cor水平均低于术后1 d,且研究组低于对照组,差异有统计学意义(P<0.05);研究组并发症发生率为8.70%(4/46),低于对照组的23.91%(11/46),差异有统计学意义(P<0.05)。结论:输尿管软镜钬激光碎石术治疗输尿管上段结石患者可提高结石清除率,缩短术后恢复时间,改善排尿功能指标水平,降低氧化应激指标水平和并发症发生率,其效果优于经皮肾镜碎石术治疗。

Objective:To observe effects of flexible ureteroscopic holmium laser lithotripsy in the treatment of patients with upper ureteral calculi.Methods:A prospective study was conducted on 92 patients with upper ureteral calculi admitted to this hospital from June 2020 to June 2023.According to the random number table method,they were divided into study group and control group,46 cases in each group.The control group was treated with percutaneous nephrolithotomy,while the study group was treated with flexible ureteroscopic Holmium laser lithotripsy.The stone clearance rate,the postoperative recovery time,the urinary function indexes[postoperative residual urine volume(RUV),maximum urinary flow rate,maximum urethral pressure(MUP)]levels before and after the surgery,the oxidative stress indexes[epinephrine(E),cortisol(Cor)]levels 1 and 7 days after the surgery,and the incidence of complications were compared between the two groups.Results:The stone clearance rate of the study group was 89.13%(41/46),which was higher than 71.74%(33/46)of the control group,and the difference was statistically significant(P<0.05).7 days after the surgery,the first out-of-bed time,the operation time and the hospitalization time in the study group were shorter than those in the control group,and the differences were statistically significant(P<0.05).7 days after the surgery,the maximum urinary flow rate and the MUP level in the two groups were higher than those 1 day before the surgery,and those in the study group were higher than those in the control group;the RUV of the two groups were lower than before the surgery,and that in the study group was lower than that in the control group;and the differences were statistically significant(P<0.05).7 days after the surgery,The levels of E and Cor in the two groups were lower than those 1 d after the surgery,those in the study group were lower than those in the control group,and the differences were statistically significant(P<0.05).Further,the incidence of complications in the study group was 8.70%(4/46),which was lower than 23.91%(11/46)in the control group,and the difference was statistically significant(P<0.05).Conclusions:Flexible ureteroscopic Holmium laser lithotripsy for the patients with upper ureteral calculi can improve the stone clearance rate,shorten the postoperative recovery time,improve the levels of urinary function indexes,and reduce the levels of oxidative stress indexes and the incidence of complications.Moreover,it is superior to percutaneous nephrolithotomy.