输尿管镜钬激光碎石术配合N-Trap网篮在输尿管上段术后复发结石中的应用效果

Application effect of holmium laser combined with N-Trap basket in ureteroscopic lithotripsy for patients with recurrent upper ureteral calculi after surgery

目的探讨输尿管镜钬激光碎石术配合N-Trap网篮在输尿管上段术后复发结石患者中的应用效果。方法选取2021年1月至2023年5月深圳市宝安区福永人民医院收治的60例输尿管上段术后复发结石患者作为研究对象,按照不同碎石方法分为对照组与观察组,每组30例。对照组采用钬激光碎石术,观察组采用钬激光碎石术配合N-Trap网篮。比较两组手术相关指标、结石清除效果、手术前后氧化应激指标、视觉模拟评分法(visual analogue scale,VAS)评分、并发症发生风险。结果两组手术时间、术中出血量、住院时间、输尿管损伤率比较,差异无统计学意义(P>0.05);观察组住院费用高于对照组,差异有统计学意义(P<0.05)。观察组结石上移率低于对照组,碎石成功率、术后清石率高于对照组,平均碎石时间短于对照组,差异均有统计学意义(P<0.05)。手术前后,两组血清C反应蛋白(C-reactive protein,CRP)、皮质醇(cortisol,Cor)比较,差异无统计学意义(P>0.05);术后7 d,两组血清CRP、Cor均高于术前,差异有统计学意义(P<0.05)。术后1、3、5、7 d,两组VAS评分先增加后下降,差异有统计学意义(P<0.05);两组VAS评分比较,差异无统计学意义(P>0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论在输尿管镜钬激光碎石术中联合N-Trap网篮对输尿管上段术后复发结石有较好清石效果,可减少结石上移,且不会增加手术难度、氧化应激改变、并发症风险。

Objective The aim of this study was to investigate the application effect of holmium laser combined with N-Trap basket in ureteroscopic lithotripsy for patients with recurrent upper ureteral calculi after surgery.Methods Sixty cases of patients who had recurrent upper ureteral calculi after surgery and were admitted to Shenzhen Bao'an District Fuyong People's Hospital from January 2021 to May 2023 were enrolled in this study.They were divided into the control group(n=30)and the observation group(n=30)according to different lithotripsy methods.Holmium laser and holmium laser combined with N-Trap basket were applied in ureteroscopic lithotripsy for the two groups,respectively.The two groups were compared in terms of surgery related indicators,effect of stone removal,oxidative stress indicators and visual analogue scale(VAS)scores before and after surgery,and the risk of complications.Results There were no statistically significant differences in surgical time,intraoperative blood loss,length of hospital stay,and ureteral injury rate between the two groups(P>0.05).Hospitalization costs of the observation group was higher than that of the control group,with a statistically significant difference(P<0.05).Compared to the control group,the rate of upward movement of stones in the observation group was lower,and the success rate of lithotripsy and postoperative stone clearance rate in the observation group were higher.The average lithotripsy time in the observation group was shorter.The differences were statistically significant(P<0.05).Serum C-reactive protein(CRP)and cortisol(Cor)levels in the two groups were comparable before surgery and on day 7 after surgery(P>0.05).Serum CRP and Cor levels in both groups on day 7 after surgery were higher than those before surgery,with statistically significant differences(P<0.05).VAS scores of the two groups increased first and then decreased on day 1,day 3,day 5,and day 7 after surgery,with statistically significant differences(P<0.05).However,there was no statistically significant difference in VAS scores between the two groups(P>0.05).The incidence rates of complications in the two groups were comparable(P>0.05).Conclusions Applying holmium laser and N-Trap basket in ureteroscopic lithotripsy can achieve good stone clearance effect on patients with recurrent upper ureteral calculi after surgery.Meanwhile,it can reduce upward movement of stones,without increasing surgical difficulty,oxidative stress changes,or the risk of complications.