球囊扩张术联合输尿管镜下钬激光碎石治疗输尿管狭窄并肾结石的效果观察

Observation of therapeutic effect of balloon dilation combined with ureteroscopic holmium laser lithotripsy on urethral stenosis complicated by kidney calculi

目的探讨球囊扩张术结合输尿管镜下钬激光碎石(URHL)治疗输尿管狭窄并肾结石的临床效果。方法队列研究。抽取2021年1月至2023年11月河南省人民医院收治的88例输尿管狭窄并肾结石患者,按随机数字表法分为对照组和观察组,每组44例。对照组行筋膜扩张器结合URHL治疗,观察组行球囊扩张术结合URHL治疗。比较两组手术情况、血清炎性因子水平、肾功能指标及并发症发生情况。结果观察组手术时间[(55.86±5.37)min]短于对照组[(67.41±6.82)min],术中出血量[(65.89±6.32)mL]少于对照组[(87.89±7.58)mL],P<0.05。术后,观察组白细胞介素-1β、超敏C反应蛋白、白细胞介素-6水平[(40.22±4.29)pg/mL、(10.25±1.13)mg/L、(42.28±4.19)pg/mL]低于对照组[(48.63±4.45)pg/mL、(12.17±1.09)mg/L、(46.69±4.14)pg/mL],P<0.05;术后,观察组血尿素氮、半胱氨酸蛋白酶抑制剂C、血肌酐水平[(10.35±1.22)mmol/L、(613.41±50.28)μg/L、(86.04±6.75)μmol/L]低于对照组[(12.29±1.28)mmol/L、(651.68±52.15)μg/L、(92.81±7.52)μmol/L],P<0.05。观察组并发症发生率(4.55%,2/44)低于对照组(18.18%,8/44),P<0.05。结论球囊扩张术结合URHL可提高输尿管狭窄并肾结石治疗效果,可在清除结石的过程中减轻手术创伤,避免术后肾功能过度减退,且并发症少。

Objective To investigate the clinical effect of balloon dilation combined with ureteroscopic holmium laser lithotripsy(URHL)in the treatment of urethral stenosis complicated by kidney calculi.Methods Eighty-eight patients with urethral stenosis complicated by kidney calculi admitted to Henan Provincial People’s Hospital from January 2021 to November 2023 were selected for the cohort study.And they were divided into a control group and an observation group by random number table method,with 44 cases in each group.The control group was treated by fascia dilator combined with URHL,while the observation group was treated by balloon dilation combined with URHL.The surgical conditions,levels of serum inflammatory factors,renal function indicators,and incidence of complications were compared between the two groups.Results The operation time in the observation group was(55.86±5.37)min,which was shorter than the(67.41±6.82)min in the control group(P<0.05);and the intraoperative blood loss in the observation group was(65.89±6.32)mL,which was less than the(87.89±7.58)mL in the control group(P<0.05).After treatment,the levels of interleukin-1β,high-sensitivity C-reactive protein and interleukin-6 in the observation group were(40.22±4.29)pg/mL,(10.25±1.13)mg/L and(42.28±4.19)pg/mL,which were lower than the(48.63±4.45)pg/mL,(12.17±1.09)mg/L and(46.69±4.14)pg/mL in the control group(P<0.05).The levels of blood urea nitrogen,cystatin C and serum creatinine in the observation group were(10.35±1.22)mmol/L,(613.41±50.28)μg/L and(86.04±6.75)μmol/L,which were lower than the(12.29±1.28)mmol/L,(651.68±52.15)μg/L and(92.81±7.52)μmol/L in the control group(P<0.05).The incidence of complications in the observation group(4.55%,2/44)was lower than that in the control group(18.18%,8/44),P<0.05.Conclusions Balloon dilation combined with URHL can improve the treatment effect of urethral stenosis complicated by kidney calculi,reduce surgical trauma during the removal of stones,and avoid postoperative renal dysfunction,with fewer complications.