二期电子输尿管软镜下钬激光碎石术治疗输尿管上段结石与肾结石的效果及对碎石成功率的影响

Effect of holmium laser lithotripsy under two-stage electronic flexible ureteroscope in the treatment of upper ureteral calculi and renal calculi and its influence on the success rate of lithotripsy

目的探讨二期电子输尿管软镜下钬激光碎石术治疗输尿管上段结石与肾结石的效果及对碎石成功率的影响。方法选取2019年12月至2021年12月收治的68例输尿管上段结石伴发肾结石的患者作为研究对象,按照治疗方案的差异将其分为对照组和研究组,各34例。对照组接受微创经皮肾镜碎石术(PCNL)治疗,研究组接受二期电子输尿管软镜下钬激光碎石术治疗。比较两组的手术相关指标、肾脏损伤指标及免疫功能指标。结果研究组的手术时间、术后住院时间、术后下床活动时间短于对照组,术中出血量少于对照组,碎石成功率高于对照组,差异具有统计学意义(P<0.05)。术后3 d,两组的肾损伤分子-1(KIM-1)、血尿素氮(BUN)、血肌酐(Scr)、β_(2)-微球蛋白(β_(2)-MG)水平均升高,但研究组低于对照组,差异具有统计学意义(P<0.05)。术后3 d,两组的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均低于术前,CD8^(+)均高于术前,差异具有统计学意义(P<0.05);术后3 d,研究组的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组,CD8^(+)低于对照组,差异具有统计学意义(P<0.05)。结论二期电子输尿管软镜下钬激光碎石术治疗输尿管上段结石与肾结石具有较高的碎石成功率,对肾功能及免疫功能的影响较小,具有临床应用价值。

Objective To explore the effect of holmium laser lithotripsy under two-stage electronic flexible ureteroscope in the treatment of upper ureteral calculi and renal calculi and its influence on the success rate of lithotripsy.Methods A total of 68 patients with upper ureteral calculi complicated with renal calculi admitted from December 2019 to December 2021 were selected as the research objects.According to the difference of treatment plan,the patients were divided into control group and study group,with 34 cases in each group.The control group was treated with minimally invasive percutaneous nephrolithotripsy(PCNL),and the study group was treated with holmium laser lithotripsy under two-stage electronic flexible ureteroscope.The operation related indexes,renal injury indexes and immune function indexes were compared between the two groups.Results The operation time,postoperative hospital stay and postoperative ambulation time of the study group were shorter than those of the control group,the intraoperative blood loss was less than that of the control group,the success rate of lithotripsy was higher than that of the control group,and the differences were statistically significant(P<0.05).At 3 d after operation,the levels of kidney injury molecule-1(KIM-1),blood urea nitrogen(BUN),serum creatinine(Scr)andβ_(2)-microglobulin(β_(2)-MG)in the two groups increased,but those in the study group were lower than the control group,and the differences were statistically significant(P<0.05).At 3 d after operation,the CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the two groups were lower than those before operation,and the CD8^(+)was higher than that before operation,the differences were statistically significant(P<0.05);at 3 d after operation,the CD3^(+),CD4^(+)and CD4^(+)/CD8^(+)in the study group were higher than those in the control group,and the CD8^(+)was lower than that in the control group,the differences were statistically significant(P<0.05).Conclusion Holmium laser lithotripsy under two-stage electronic flexible ureteroscope has a high success rate of lithotripsy in the treatment of upper ureteral calculi and renal calculi,and has little effect on renal function and immune function,which has clinical application value.