可弯曲负压吸引鞘联合一次性输尿管软镜碎石术治疗2~3 cm上尿路结石的疗效

Efficacy of FURL with FV-UAS for 2-3 cm upper urinary tract stones

目的探讨可弯曲负压吸引鞘(FV-UAS)联合一次性输尿管软镜碎石术(FURL)治疗2~3 cm上尿路结石的效果,为结石治疗方式的选择提供参考。方法回顾性分析2022年4月—2023年10月于南京医科大学附属江宁医院接受FV-UAS联合FURL或微创经皮肾镜碎石取石术(MPCNL)治疗的178例上尿路结石患者的临床资料。根据手术方式不同将患者分为FV-UAS组(90例,行FV-UAS联合一次性FURL治疗)和MPCNL组(88例,行MPCNL治疗),比较两组患者的一般资料、围术期资料和术后清石率(SFR)。结果两组患者手术均顺利完成,FV-UAS组手术时间显著长于MPCNL组[(66.5±6.7)min vs.(63.9±7.4)min,P=0.015],而FV-UAS组术中血红蛋白降低水平[(7.3±3.1)g/L vs.(11.4±5.9)g/L]、术后住院时间[(2.2±0.7)d vs.(5.4±1.3)d]及视觉模拟评分(VAS)[(2.7±0.9)分vs.(5.6±1.1)分]均明显低于MPCNL组(P<0.001)。MPCNL组的持续性肉眼血尿发生率显著高于FV-UAS组(12.5%vs.3.3%,P=0.023)。FV-UAS组术后即刻SFR(83.3%)及最终SFR(95.6%)均与MPCNL组(89.8%,96.6%)相当(P>0.05)。结论FV-UAS联合一次性FURL治疗2~3 cm上尿路结石具有较高的SFR和较低的并发症发生率,患者的痛苦较小、恢复较快,值得在临床上推广和应用。

Objective To explore the efficacy of disposable flexible ureteroscopic lithotripsy(FURL)with flexible vacuum-assisted ureteral access sheath(FV-UAS)in the treatment of 2-3 cm upper urinary tract stones,so as to provide reference for the treatment selection.Methods Clinical data of 178 patients with upper urinary tract stones who received FURL or minimally invasive percutaneous nephrolithotomy(MPCNL)at our hospital during Apr.2022 and Oct.2023 were retrospectively analyzed.The patients were divided into FV-UAS group(n=90,received FV-UAS combined with diaposable FURL treatment)and MPCNL group(n=88,received MPCNL).The general information,perioperative data,and postoperative stone-free rate(SFR)of the two groups were compared.Results All operations were successfully completed.The operation time was significantly longer in the FV-UAS group than in the MPCNL group[(66.5±6.7)min vs.(63.9±7.4)min,P=0.015].However,the intraoperative hemoglobin reduction[(7.3±3.1)g/L vs.(11.4±5.9)g/L],postoperative hospital stay(P<0.001)[(2.2±0.7)d vs.(5.4±1.3)d],and visual analogue score(VAS)[(2.7±0.9)vs.(5.6±1.1)]were significantly lower in the FV-UAS group than in the MPCNL group(P<0.001).The incidence of persistent gross hematuria was significantly higher in the MPCNL group than in the FV-UAS group(12.5%vs.3.3%,P=0.023).The FV-UAS group had a similar postoperative immediate(83.3%)and final SFR(95.6%)to those of the MPCNL group(89.8%,96.6%,P>0.05).Conclusion The combination of FURL with FV-UAS for 2-3 cm upper urinary tract stones has a higher SFR and a lower complication rate.Patients experience endurable pain and fast recovery,which is worth promoting and applying in clinical practice.