Multi-aspect analysis of ureteral access sheath usage in retrograde intrarenal surgery: A RIRSearch group study

Objective:To evaluate the effect of ureteral access sheath(UAS)use and calibration change on stone-free rate and complications of retrograde intrarenal surgery(RIRS).Methods:Data from 568 patients undergoing RIRS for kidney or upper ureteral stones were retrospectively included.Firstly,patients were compared after 1:1 propensity score matching,according to UAS usage during RIRS(UAS used[+]87 and UAS non-used[−]87 patients).Then all UAS+patients(n=481)were subdivided according to UAS calibration:9.5-11.5 Fr,10-12 Fr,11-13 Fr,and 13-15 Fr.Primary outcomes of the study were the success and complications of RIRS.Results:Stone-free rate of UAS+patients(86.2%)was significantly higher than UAS−patients(70.1%)after propensity score matching(p=0.01).Stone-free rate increased with higher caliber UAS(9.5-11.5 Fr:66.7%;10-12 Fr:87.0%;11-13 Fr:90.6%;13-15 Fr:100%;p<0.001).Postoperative complications of UAS+patients(11.5%)were significantly lower than UAS−patients(27.6%)(p=0.01).Complications(8.7%)with 9.5-11.5 Fr UAS was lower than thicker UAS(17.2%)but was not statistically significant(p=0.09).UAS usage was an independent factor predicting stone-free status or peri-and post-operative complications(odds ratio[OR]3.654,95%confidence interval[CI]1.314-10.162;OR 4.443,95%CI 1.350-14.552;OR 4.107,95%CI 1.366-12.344,respectively).Conclusion:Use of UAS in RIRS may increase stone-free rates,which also increase with higher caliber UAS.UAS usage may reduce complications;however,complications seemingly increase with higher UAS calibration.

Retrograde intrarenal surgery for lower pole stones utilizing stone displacement technique yields excellent results

Objective:To evaluate the long-term stone-free rate(SFR)of retrograde intrarenal surgery(RIRS)in the treatment of lower pole renal calculi using only basket relocation and identify independent predictors of stone-free status.Methods:All consecutive patients undergoing RIRS lower pole renal calculi at a single highvolume tertiary center were analyzed retrospectively.Lower pole stones were relocated to the upper pole,where laser lithotripsy was performed.All patients were followed up in the clinic following the surgery and yearly thereafter.The stone-free status was assessed with a combination of an abdominal ultrasound and abdominal X-ray,or an abdominal non-contrast computed tomography if the stones were known to be radiolucent.Results:A total of 480 consecutive patients who underwent RIRS for treatment of lower pole renal calculi,between January 2012 and December 2018,were analyzed from a prospectively maintained database of 3000 ureteroscopies.With a median follow-up time of 18.6 months,the mean SFR was 94.8%.The procedures were unsuccessful in 26(5.4%)patients due to unreachable stones.The median stone size of the unreachable stones was 12 mm(range 10e30 mm).Multivariable logistic regression analysis revealed two predictors of SFR for lower pole stones:a small cumulative stone burden(odds ratio[OR]:0.903,95%confidence interval[CI]:0.867e0.941,p<0.0001)and preoperative ureteral stent insertion(OR:0.515,95%CI:0.318e0.835,pZ0.007).Conclusion:The long-term SFR of RIRS for the treatment of lower pole stones with basket displacement with appropriate patient selection is high.

Retrograde intrarenal surgery vs miniaturized percutaneous nephrolithotomy to treat lower pole renal stones 1.5-2.5 cm in diameter

AIM To compare the outcomes of retrograde intrarenal surgery(RIRS) and miniaturized percutaneous nephrolithotomy(mini-PCNL) in treating lower pole(LP) renal stones with a diameter of 1.5-2.5 cm.METHODS A total of 216 patients who underwent mini-PCNL(n = 103) or RIRS n = 113) for LP stones with a diameter of 1.5-2.5 cm were enrolled between December 2015 and April 2017 at the Urology Department of Ningbo Urology and Nephrology Hospital.RESULTS Significant differences were found in the hospital stay(9.39 ± 4.01 vs 14.08 ± 5.26, P < 0.0001) and hospitalization costs(2624.5 ± 513.36 vs 3255.2 ± 976.5, P < 0.0001) between the RIRS and mini-PCNL groups. The mean operation time was not significantly different between the RIRS group(56.48 ± 24.77) and the mini-PCNL group(60.04 ± 30.38, P = 0.345). The stone-free rates at the first postoperative day(RIRS vs mini-PCNL: 90.2% vs 93.2%, P = 0.822) and the second month postoperatively(RIRS vs mini-PCNL: 93.8% vs 95.1%, P = 0.986) were not significantly different.CONCLUSION RIRS and mini-PCNL are both safe and effective methods for treating LP stones with a diameter of 1.5-2.5 cm. RIRS can be considered as an alternative to PCNL for the treatment for LP stones of 1.5-2.5 cm.

Retrograde intrarenal surgery:An expanding role in treatment of urolithiasis

During the past 3 decades,the surgical management of kidney stones has undergone many technological advances and one is the development of the flexible ureteroscopy.The development of this instrument as well as ancillary equipment such as baskets,graspers,and others,and improvements in lithotripsy with Holmium:YAG laser have led to expand its indications with diagnostic and therapeutic management of medical issues of the upper urinary tract such as urolithiasis and urothelial tumors.The objective of this review is to describe its indications and results in the different scenarios for the treatment of urinary stones.

Use of a new retrograde filling material(Biodentine) for endodontic surgery: two case reports

Mineral trioxide aggregate（MTA） is considered at the present time as the gold standard for root-end filling in endodontic surgery.However, this biocompatible material presents several drawbacks such as a long setting time and handling difficulties. The aim of this article is to present a new commercialized calcium silicate-based material named Biodentine with physical improved properties compared to MTA in a clinical application. Two endodontic microsurgeries were performed by using specific armamentarium（microsurgical instrumentation, ultrasonic tips） under high-power magnification with an operatory microscope. Biodentine was used as a root-end filling in order to seal the root canal system. The two cases were considered completely healed at 1 year and were followed for one more year. The 2-year follow-up consolidated the previous observation with absence of clinical symptoms and radiographic evidence of regeneration of the periapical tissues.

Retrograde intrarenal surgery in pediatric patients

Urinary tract stone disease is seen at a level of 1%-2% in childhood(< 18 years).In recent years,however,there has been a marked increased in pediatric stone disease,particularly in adolescence.A carbohydrateand salt-heavy diet and a more sedentary lifestyle are implicated in this increase.Although stone disease is rare in childhood,its presence is frequently associated with metabolic or anatomical disorders or infectious conditions,for which reason there is a high possibility of post-therapeutic recurrence.Factors such as a high possibility of recurrence and increasing incidence further enhance the importance of minimally invasive therapeutic options in children,with their expectations of a long life.In children in whom active stone removal is decided on,the way to achieve the highest level of success with the least morbidity is to select the most appropriate treatment modality.Thanks to today's advanced technology,renal stones that were once treated only by surgery can now be treated with minimally in-vasive techniques,from invasion of the urinary system in an antegrade(percutaneous nephrolithotomy) or retrograde(retrograde intrarenal surgery) manner or shock wave lithotripsy to laparoscopic stone surgery.This compilation study examined studies involving the RIRS procedure,the latest minimally invasive technique,in children and compared the results of those studies with those from other techniques.

Sheathless and fluoroscopy-free retrograde intrarenal surgery:An attractive way of renal stone management in high-volume stone centers

Objective:To evaluate the efficacy and safety of sheathless and fluoroscopy-free flexible ureterorenoscopic laser lithotripsy(FURSL)for treating renal stones.Methods:Between May 2015 and May 2017,135 patients with renal stones treated with sheathless and fluoroscopy-free FURSL were prospectively evaluated.Our technique involved a semirigid ureteroscopic assessment of the ureter,and the guidewire was left in situ to railroad the flexible ureteroscope.A holmium laser was used to fragment and dust the stones;fragments were neither grasped nor collected.Results:The study population consisted of 135 patients including 85 males(62.96%)and 50 females(37.04%)with a mean age of 40.65 years(range:3-70 years)were evaluated.The mean stone size was 17.23 mm(range:8-41 mm).Complete stone-free status was achieved in 122(90.37%)patients and clinically insignificant residual fragments(CIRF)in two(1.48%),while residual stones were still present in 11(8.15%)patients.Postoperative complications occurred in 23(17.4%)cases and were mostly minor,including fever in 17(12.6%),pyelonephritis in four(3.0%),subcapsular hematoma in one(0.7%)and steinstrasse in one(0.7%).These complications were Clavien Ⅰ-Ⅱ,GⅠ in 17(12.6%)patients,GⅡ in five(3.7%),and Clavien Ⅲb in one(0.7%).No major complications were observed.Stone size2 cm,operative time ≥30 min,and lasing time ≥20 min were significantly associated with a higher rate of complications and lower stone-free rates upon univariate analysis(p<0.05).Conclusion:Sheathless and fluoroscopy-free FURSL are effective and safe for renal stone management,especially for stones under 2 cm in diameter.This process is a feasible option for avoiding sheath complications,which can protect surgeons from the negative effects of radiation.

Massive retroperitoneal hematoma as an acute complication of retrograde intrarenal surgery:A case report

BACKGROUND Retrograde intrarenal surgery(RIRS)has been proven to be a safe and effective treatment modality in large-scale quantitative studies.However,although its safety profile has been established,it also has a potential risk of life-threatening complications.We here describe our experience with a patient who developed a huge periureteral hematoma after RIRS with holmium laser lithotripsy.CASE SUMMARY A 73-year-old woman visited our center with a complaint of gross hematuria.An enhanced computed tomography(CT)scan revealed a 1.5-cm left renal pelvis stone with hydronephrosis.The patient underwent RIRS.During the surgery,a 12/14-Fr ureteral access sheath was applied and a 6-Fr ureteral catheter was indwelled thereafter.On postoperative day 1,she experienced aggravated left flank pain and left lower-quadrant tenderness without rebound tenderness.A follow-up CT scan was taken,which revealed a huge hematoma in the periureteral space,not in the perirenal space,with suspicious contrast medium extravasation.Immediate angiography was performed;however,it showed no evidence of active bleeding.She was conservatively managed with hydration and antibiotic and nonsteroidal anti-inflammatory drug therapy,and was discharged on postoperative day 7.However,she visited our outpatient department with recurrent left flank pain at 5 d from discharge.Ultrasonography confirmed that the double J-stent was intact.To rule out stent malfunction,the stent was changed.Decreased size of the hematoma was observed in the imaging studies,and conservative management for candiduria was performed for 1 wk.CONCLUSION Although RIRS is an effective and safe procedure for the management of renal stones,clinicians should be aware of its potential complications.

Comparison of the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi

Objective: To compare the trauma between combined retrograde intrarenal surgery and mini-percutaneous nephrolithotomy for upper ureteral calculi. Methods: Patients with upper ureteral calculi who received lithotripsy in Pengzhou Hospital of Traditional Chinese Medicine between February 2015 and March 2017 were selected and randomly divided into two groups;RIRS group received combined retrograde intrarenal surgery and the Mini-PCNL group received mini-percutaneous nephrolithotomy. 3 d after surgery;the contents of liver and kidney function indexes and stress hormones in serum as well as the expression of CD4+T cell transcription factors in peripheral blood were measured. Results: Serum ALT;AST;γ-GT;BUN and Cr contents of RIRS group 3 d after surgery were not significantly different from those of Mini-PCNL group;and HO-1;ET-1;ACTH;Cor and YKL-40 contents in serum as well as RORγt and T-bet mRNA expression in peripheral blood were significantly lower than those of Mini-PCNL group while Gata-3 and Foxp3 mRNA expression in peripheral blood were higher than those of Mini-PCNL group. Conclusion: Combined retrograde intrarenal surgery for upper ureteral calculi activates less stress response and inflammatory response than mini-percutaneous nephrolithotomy.

Clinical application of retrograde cerebral perfusion for brain protection during the surgery of ascending aortic aneurysm:50 cases report

Objective To assess retrospectively the effects of different protective methods on brain in ascending aortic aneurysm surgery. Methods In 65 patients, aneurysm was dissected to the aortic arch or right arch. To protect brain, deep hypotermic circulatory arrest ( DHCA.) combined with retrograde cerebral perfusion ( RCP) June 2003 Vol11 No2 through the superior vena cava ( n = 50) and simple DHCA ( n = 15) were used during the procedure. Blood samples for lactic acid level from the jugular vein were compared in both groups at different plase, and perfusion blood distribution and oxygen content difference between the perfused and returned blood were measured in some RCP patients. Results The DHCA time was 35.9 ± 8 min (10. 0 - 63. 0 min) and DHCA+ RCP time was 45.5 ± 17. 2 min (16. 0 - 81. 0 min)The resuscitationtime was 7.1 ± 1.6 h (4.4 - 9.4H)in DHCA patients and 5.4±2.2h(2.0-9.0 h)in RCP patients. Operation death was 3/15 in the DHCA group and 1/50 in the RCP patients. Central nervous complication

Stanford B型主动脉夹层胸主动脉腔内修复术后再发Stanford A型主动脉夹层的外科治疗

目的 总结Stanford B型主动脉夹层胸主动脉腔内修复术(TEVAR)后再发Stanford A型主动脉夹层的手术治疗经验。方法 收集2015年1月至2022年12月于新疆医科大学第一附属医院进行手术治疗的10例Stanford B型主动脉夹层TEVAR术后再发Stanford A型主动脉夹层患者的临床资料。所有患者出院后均通过门诊或电话的方式进行随访,随访时间为18~102个月。记录患者的治疗情况、随访结果。结果 所有患者均顺利完成手术,围手术期无死亡。5例患者术后发生了主要并发症,包括低心排出量综合征1例,脑梗死2例,肾功能不全1例,切口感染1例。2例患者于术后1、13个月死于急性脑出血,1例患者于术后4年发生脑梗死。1例患者升主动脉人工血管置换术后1年发现胸腹主动脉瘤样扩张,患者拒绝手术,选择长期密切随访。结论 Stanford B型主动脉夹层TEVER术后再发Stanford A型主动脉夹层外科手术治疗可取得良好疗效。

单通道经皮肾镜联合输尿管软镜治疗合并肾盏颈口狭窄的复杂肾结石疗效观察

目的 探讨单通道经皮肾镜取石术(PCNL)联合输尿管软镜碎石术(RIRS)治疗合并肾盏颈口狭窄的复杂性肾结石的安全性及疗效。方法 回顾性分析2019年7月至2022年2月金华市中心医院收治的26例合并肾盏颈口狭窄的复杂性肾结石患者。所有患者均存在不同程度肾盏颈口狭窄伴肾盏积水,其中狭窄位于上盏21例,中盏3例,下盏2例;3例双侧肾结石,14例肾及输尿管多发结石,18例鹿角形结石。结石大小(40.6±13.5)mm,CT值(1 124.7±364.0)HU,结石负荷评分系统评分(8.7±0.8)分。所有患者均采用顺行PCNL联合RIRS。结果 26例患者均顺利完成手术并扩张狭窄通道留置双J管,平均手术时间(110.8±36.2)min。术中、术后均无严重出血和感染并发症。泌尿手术后并发症评分系统Ⅰ、Ⅱ级并发症发生率分别为7.7%(2例)、15.4%(4例),无Ⅲ级以上并发症。术后1个月复查腹部CT,一期结石取净率80.8%(21/26),二期结石取净率92.3%(24/26)。术后2~14 d拔除肾造瘘管,术后1~3个月拔除双J管。术后随访3~12个月,未见狭窄复发。结论 PCNL联合RIRS治疗合并肾盏颈口狭窄复杂性肾结石可有效扩张狭窄通道,结石取净率高且并发症少,是一种安全有效的治疗方案。

输尿管软镜碎石取石术治疗直径≤2 cm的肾结石的疗效及对肾功能和炎症相关指标的影响

目的 分析输尿管软镜碎石取石术(RIRS)治疗肾结石(直径≤2 cm)的疗效及对肾功能和炎症的影响。方法 选取2020年1月-2022年12月该院收治的肾结石(直径≤2 cm)患者194例,采用随机数表法分为超微经皮肾镜取石术(SMP)组(97例)和RIRS组(97例),分别给予SMP和RIRS治疗,两组患者术后均随访1周。比较两组患者手术情况、肾功能、应激反应、炎症相关指标和并发症发生情况。结果RIRS组肾造瘘管留置时间和住院时间短于SMP组,术中出血量少于SMP组,差异均有统计学意义(P <0.05)。两组患者术后1周血清半胱氨酸蛋白酶抑制剂C (Cys-C)、血肌酐(Scr)、尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1 (KIM-1)水平,以及术后24 h血清活性氧(ROS)、肾上腺素(AD)、去甲肾上腺素(NA)、促肾上腺皮质激素(ACTH)、脂质过氧化物(LPO)、白细胞介素-6 (IL-6)、前列腺素E2 (PGE2)和超敏C反应蛋白(hs-CRP)水平较术前升高,且RIRS组低于SMP组,差异均有统计学意义(P <0.05)。RIRS组随访期间的并发症总发生率低于SMP组,差异有统计学意义(P <0.05)。结论 与SMP相比,RIRS治疗肾结石(直径≤2 cm),具有创伤小、出血少、肾功能损害小、术后应激反应轻、炎症反应轻和安全性高等优势,可促进患者术后恢复。

逆行肾内手术治疗直径2~3cm肾结石的临床应用

目的 探讨逆行肾内手术(RIRS)治疗直径2~3 cm肾结石的临床应用。方法 选取2022年1月到2023年3月我院诊治的直径2~3 cm肾结石患者80例,根据手术方式的不同分为观察组(逆行肾内手术RIRS组,n=40)和对照组(经皮肾镜碎石术PCNL组,n=40)。比较两组患者一般情况和结石特征、术中指标及术后恢复情况。结果 两组患者各项一般情况数据和结石特征比较差异无统计学意义(P>0.05);RIRS组患者血红蛋白下降量低于PCNL组,差异有统计学意义(P<0.05),其余围手术期数据比较差异无统计学意义(P>0.05);RIRS组患者术后住院时间、总并发症低于PCNL组,差异有统计学意义(P<0.05);术后一个月,RIRS组结石清除34例(85.00%),PCNL组患者结石清除36例(90.00%),两组结石清除率比较差异无统计学意义(P>0.05)。结论对于直径2~3 cm的较大肾结石患者采用输尿管软镜碎石术与经皮肾镜碎石术的手术时间、结石清除率、引起术后PCT的升高方面相当,输尿管软镜碎石术患者出血更少,恢复更快,术后住院时间更短,并发症发生率更低。

三金化石汤辅助输尿管软镜术治疗肾结石的效果

目的研究三金化石汤辅助输尿管软镜术(RIRS)治疗肾结石的临床效果,并分析其作用机制。方法选择2016年1月至2022年11月在河南中医药大学第一附属医院接受治疗的110例肾结石患者,按照随机数表法进行分组,对照组55例接受RIRS治疗,研究组55例接受RIRS、三金化石汤辅助治疗。比较两组结石清除率、肾功能[血肌酐(SCr)、胱抑素C(Cys-C)、尿素氮(BUN)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)]、炎症反应[肿瘤坏死因子-α(TNF-α)、白介素-1β(IL-1β)、白介素-6(IL-6)及C反应蛋白(CRP)]、生活质量及并发症。结果研究组治疗2周后结石清除率(98.18%)较对照组(85.45%)高(P<0.05);两组治疗2周后SCr、Cys-C、BUN、NGAL、TNF-α、IL-1β、IL-6、CRP均降低,且研究组更低(P<0.05);两组治疗2个月后世界卫生组织生活质量简表各项评分均升高,且研究组更高(P<0.05);两组并发症发生率相比(7.27%比3.64%),差异无统计学意义(P>0.05)。结论三金化石汤辅助RIRS治疗肾结石效果确切,可有效提升结石清除率,促进肾功能恢复,改善生活质量,未增加并发症。

脑室腹腔分流术后逆行感染的诊断及风险:1例病例报道

1病例资料患者,男,27岁,因“意识不清17个月余,反复发热50余天”收入南京医科大学第一附属医院。患者入院前5个月外院行“全麻下下颌骨接骨”手术,术中出现血压、血氧测不出,查体大动脉搏动微弱,胸前区大片红斑,立即停止手术,行床边心肺复苏,同时给予“肾上腺素、甲强龙”静推。术后出现意识不清伴肢体活动障碍,转至外院行气管插管呼吸机辅助通气、脱水降颅压、控制癫痫等治疗.

肾盏憩室结石腔内手术治疗单中心分析并文献复习

目的分析不同腔内手术治疗肾盏憩室患者的疗效,为提高此类疾病的诊治水平提供参考。方法回顾性分析广州医科大学附属第一医院2025年1月—2021年12月收治的21例肾盏憩室结石患者的临床资料。依据手术方法将患者分为经尿道输尿管软镜手术组(RIRS组,n=14)和经皮肾镜手术组(PCNL组,n=7),并进行组间数据分析。结果RIRS组和PCNL组结石最大径分别为(11.56±4.79)mm和(13.06±6.27)mm,差异无统计学意义(P=0.609)。RIRS组与PCNL组在憩室顶肾实质厚度[(10.08±4.81)mm vs.(5.24±2.23)mm,P=0.005]、手术时间[(58.57±19.23)min vs.(88.29±25.28)min,P=0.007]、住院时间[3(1,5)d vs.11(5,12)d,P=0.023]方面比较差异有统计学意义。而两组术后结石清除率、血红蛋白下降值、术后并发症情况比较差异无统计学意义(P>0.05)。结论对于肾盏憩室结石,RIRS和PCNL都是可供选择的手术方式,RIRS的手术时间和住院时间更短,PCNL可在RIRS手术失败时作为替代手术方式。

Safety of high-carbohydrate fluid diet 2 h versus overnight fasting before non-emergency endoscopic retrograde cholangiopancreatography:A single-blind,multicenter,randomized controlled trial

Background:Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography(ERCP),the benefits and safety of high-carbohydrate fluid diet(CFD)intake 2 h before ERCP remain unclear.This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’recovery.Methods:This prospective,multicenter,randomized controlled trial involved 15 tertiary ERCP centers.A total of 1330 patients were randomized into CFD group(n=665)and fasting group(n=665).The CFD group received 400 mL of maltodextrin orally 2 h before ERCP,while the control group abstained from food/water overnight(>6 h)before ERCP.All ERCP procedures were performed using deep sedation with intravenous propofol.The investigators were blinded but not the patients.The primary outcomes included postoperative fatigue and abdominal pain score,and the secondary outcomes included complications and changes in metabolic indicators.The outcomes were analyzed according to a modified intention-to-treat principle.Results:The post-ERCP fatigue scores were significantly lower at 4 h(4.1±2.6 vs.4.8±2.8,t=4.23,P<0.001)and 20 h(2.4±2.1 vs.3.4±2.4,t=7.94,P<0.001)in the CFD group,with least-squares mean differences of 0.48(95%confidence interval[CI]:0.26-0.71,P<0.001)and 0.76(95%CI:0.57-0.95,P<0.001),respectively.The 4-h pain scores(2.1±1.7 vs.2.2±1.7,t=2.60,P=0.009,with a least-squares mean difference of 0.21[95%CI:0.05-0.37])and positive urine ketone levels(7.7%[39/509]vs.15.4%[82/533],χ^(2)=15.13,P<0.001)were lower in the CFD group.The CFD group had significantly less cholangitis(2.1%[13/634]vs.4.0%[26/658],χ^(2)=3.99,P=0.046)but not pancreatitis(5.5%[35/634]vs.6.5%[43/658],χ^(2)=0.59,P=0.444).Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla(odds ratio[OR]:0.61,95%CI:0.39-0.95,P=0.028)in the multivariable models.Conclusion:Ingesting 400 mL of CFD 2 h before ERCP is safe,with a reduction in post-ERCP fatigue,abdominal pain,and cholangitis during recovery.Trail Registration:ClinicalTrials.gov,No.NCT03075280.

40~80 Hz钬激光微通道经皮肾镜与输尿管软镜手术治疗肾结石患者的疗效比较

目的比较微通道经皮肾镜碎石取石术(mPCNL)和输尿管软镜碎石术(RIRS)两种方式下利用高频率钬激光治疗2~3 cm肾结石的临床疗效。方法回顾性分析嘉兴市第一医院泌尿外科2020年10月—2022年10月收治的105例单发2~3 cm肾结石患者的临床资料,其中52例采用RIRS利用40~80 Hz钬激光碎石(RIRS组),53例采用mPCNL利用40~80 Hz钬激光碎石(mPCNL组)。比较两组的结石一期清除率、手术时间、24 h内血红蛋白(Hb)下降量、术后24 h内炎症指标、术后并发症发生率、住院时间、住院费用。结果两组患者术前基本资料、一期清除率、术后24 h内炎症指标及术后并发症发生率,差异无统计学意义(P>0.05)。RIRS组较mPCNL组术后24 h内Hb下降量更少[(6.35±2.00)g/L vs.(12.25±5.72)g/L,P=0.001],住院时间较短[(5.13±0.82)d vs.(7.92±1.59)d,P<0.001],住院费用更少[(15221.52±796.46)元vs.(19514.51±909.98)元,P<0.001],而手术时间更长[(58.17±7.67)min vs.(49.60±4.52)min,P<0.001]。结论在钬激光频率为40~80 Hz情况下行mPCNL和RIRS治疗2~3 cm肾结石均安全有效,且一期清石率相近,而RIRS虽较mPCNL的手术时间长,但具有手术创伤更小、术后恢复更快、住院时间更短的优点,在2~3 cm肾结石的治疗中可能更具优势和前景。

经皮肾镜联合输尿管软镜取石术治疗输尿管结石合并同侧肾结石的效果研究

目的分析经皮肾镜联合输尿管软镜取石术(RIRS)治疗输尿管结石合并同侧肾结石的应用优势。方法选取2020年1月—2023年1月150例输尿管结石合并同侧肾结石患者,随机分为2组各75例,肾镜组行经皮肾镜取石术(PCNL),双镜组采用PCNL联合RIRS。比较2组围术期指标、术后并发症发生率、术后视觉模拟评分法(VAS)评分及尿液代谢异常发生率,术前及术后神经源炎症反应指标[神经生长因子(NGF)、前列腺素E_(2)(PGE_(2))、C反应蛋白(CRP)、P物质(SP)]、肾功能指标[血清肌酐(Cr)、尿素(UREA)、肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关载脂蛋白(NGAL)]。结果双镜组手术时间、住院天数短于肾镜组,术中出血量低于肾镜组,术后3 d、术后1个月结石清除率高于肾镜组(P<0.01)。双镜组术后并发症发生率为2.67%(2/75)低于肾镜组的12.00%(9/75)(P<0.05)。双镜组术后6、12、24、48 h VAS评分低于肾镜组(P<0.05)。双镜组术后24、48 h NGF、PGE_(2)、CRP及SP均低于肾镜组(P<0.05)。术后1周、2周双镜组Cr、UREA、KIM-1及NGAL低于肾镜组(P<0.05)。双镜组术后2周高尿酸尿症、高草酸尿症、低枸橼酸尿症、高钙尿症及低镁尿症发生率均较肾镜组低(P<0.05)。结论PCNL联合RIRS治疗输尿管结石合并同侧肾结石患者可优化手术操作,抑制神经源炎症反应,减轻术后疼痛与肾功能损伤,且能提高结石清除率,降低并发症风险,改善尿液代谢状态。