灌注方式在输尿管软镜治疗上尿路结石中的适用及安全性研究

Study on the applicability and safety of perfusion method in the treatment of upper urinary tract stones with flexible ureteroscopy

目的:分析对比2种灌注方式在输尿管软镜治疗上尿路结石手术中的安全性及可靠性。方法:回顾性比较分析2022年10月—2023年10月什邡市人民医院使用手工推注和改良自动灌注模式下进行输尿管软镜碎石术(retrograde intrarenal surgery,RIRS)治疗的82例上尿路结石患者的手术时间、耗水量、清石率及感染、疼痛和出血等并发症的发生率。结果:手工推注模式下手术时间为(62.6±28.2)min,耗水量为(2280±417)mL,清石率为92.5%,住院时间为(6.2±1.1)d;术后发热6例,腰痛10例,肾盂积血2例。改良自动灌注模式下手术时间为(53.2±21.8)min,耗水量为(2092±356)mL,清石率为95.2%,住院时间为(5.1±1.6)d;术后发热1例,腰痛2例。2种模式下手术时间比较差异无统计学意义,但改良自动灌注模式下住院时间更短,术中耗水量更少,清石率更高,发热及疼痛等并发症显著减少,差异均有统计学意义(P<0.05)。结论:采用改良自动灌注模式下进行RIRS更安全方便,值得普及推广并取代手动注水灌注方式。

Objective To analyze and compare the safety and reliability between two perfusion methods in the treatment of upper urinary tract stones with flexible ureteroscopy.Methods A retrospective comparative analysis was conducted on the surgical time, water consumption, stone clearance efficiency, and incidence of complications such as infection, pain, and bleeding in 82 patients with upper urinary tract stones treated with retrograde intrarenal surgery(RIRS) using manual infusion and improved automatic infusion mode in the past year.Results Data of the manual injection time (62.6±28.2) minutes, water consumption (2 280±417) mL, stone clearance rate 92.5%, hospital stay (6.2±1.1) days, postoperative fever in 6 cases, low back pain in 10 cases, and renal pelvic hemorrhage in 2 cases were compared to data of the improved automatic perfusion time (53.2±21.8) minutes, water consumption (2 092±356) mL, stone removal rate 95.2%, hospital stay (5.1±1.6) days, postoperative fever in 1 case, and low back pain in 2 cases. Results showed no significant difference in operation time between the two perfusion methods. However, shorter hospitalization time, less intraoperative water consumption, higher stone clearance rate, and significantly fewer complications such as fever and pain were found in the latter one, and all the results were statistically significant(P < 0.05).Conclusion The use of improved automatic infusion for RIRS is safer and more convenient, so is worth promoting and replaces manual infusion.