Analysis of the effect of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts

Objective:To explore the efficacy,safety,and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts.Methods:From September 2012 to February 2019,a total of 18 patients,aged from 28 to 62(meanstandard deviation[SD]:46.50±9.14)years,were diagnosed with parapelvic renal cysts and treated by holmium laser flexible ureteroscopic intrapelvic drainage.There were 10 males and eight females.All of the parapelvic renal cysts were unilateral,and two cases were complicated with pyelolithiasis.The diameters of the cysts ranged from 4.1 cm to 8.2 cm.Results:All the patients completed the operation successfully in one stage without conversion to open surgery;in two cases,it was difficult to find the cysts during the operation,and the localization was completed by B-ultrasound and percutaneous injection of methylene blue.The mean operative time was 33.89(SD:9.68;range:22-54)min,and the mean hospitalization time was 2.67(SD:0.91;range:2-5)days.Three months and 6 months of follow-up were performed after surgery.The cysts disappeared in 13(72%)cases,and the diameter of the cysts in five(28%)cases decreased by more than 50%.Conclusion:Holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts is simple,safe,and effective,and can be used as the first choice for the treatment of parapelvic renal cysts.

Flexible ureteroscopy:Technological advancements,current indications and outcomes in the treatment of urolithiasis

The last 3 decades have witnessed great improvements in the technology and clinical applications of many minimally invasive procedures in the urological field.Flexible ureteroscopy(fURS)has advanced considerably to become a widely utilized diagnostic and therapeutic tool for multiple upper urinary tract pathologies.The most common indication for fURS is the treatment of upper urinary tract stones with the aid of Holmium:Yttrium Aluminium Garnet(YAG)laser lithotripsy.Advancements in endoscope technologies and operative techniques have lead to a broader application of fURS in the management of urolithiasis to include larger and more complex stones.fURS has proved to be an effective and safe procedure with few contraindications.Continued progression in fURS may increase its clinical applicability and supplant other procedures as the first line treatment option for urolithiasis.

Ureteroscopy with Holmium: YAG Laser—A Initial Study in the Urology Department of the Pr Bocar Sidy Sall University Hospital of Kati

Introduction: Ureteroscopy is a minimally invasive endoscopic surgery which provides access to the ureter, pyelon and calyceal cavities via the urethra and the bladder. Laser ureteroscopy uses the laser as an energy source to treat the stone and eliminate it naturally. Minimally invasive endoscopic methods are struggling to become popular in sub-Saharan African countries, especially for the upper urinary tract. The objective of our work was to report the results of our first laser ureteroscopy experience in the department. Materials and Methods: This was a prospective and descriptive study running from December 1, 2023 to February 19, 2024. Included in our study was any case of upper urinary tract stone operated by Laser ureteroscopy. The characteristics of the lithiasis were determined by CT scan. Sterilization of urine was verified by carrying out a cytobacteriological examination of urine. Ureteral lithiasis was approached by semi-rigid ureteroscopy. Renal lithiasis was immediately addressed by flexible ureteroscopy. Ureteroscopy was coupled with a Holmium YAG laser. A double J ureteral catheter was placed after the operation. A 230 µm laser fiber was used in each case with a generator with a power of 35 watts (Storz Calculase III type). An access sheath was used in all cases of flexible ureteroscopy. The parameters studied were: sociodemographic characteristics, lithiasis (site, size, number, density, topography), type of anesthesia, duration of laser use, duration of intervention, postoperative outcomes. Data entry and analysis were carried out using the software (Word 2016 and SPSS). Result: We collected 30 cases of laser ureteroscopy. The average age was 37 years with extremes of 9 and 79 years. The male gender was more represented. The most common age group was 24-39 years old. Renal colic was the most frequent reason for admission, 12 patients (40%). On physical examination, lumbar tenderness was present in 47% (14 patients). ECBU was positive in 4 patients (13%). CT scan was performed in all our patients before the intervention. The average stone size was 12 mm and the largest was 23 mm. The majority of stones, i.e. 59% (18 patients), had a density greater than 1000 HU. The stone was unique in 19 patients (63%). The location of the stone was pyelic in 8 patients or 27%. An impact on the upper urinary tract was found in 16 of our patients or 53%. General anesthesia was used in 25 patients (83%). A digital flexible ureteroscopy was used in 24 patients and a semi-rigid ureteroscopy (URS) in 6 patients. Full-course fragmentation was the most used therapeutic method, 9 patients or 32%. The average duration of interventions was 61 minutes. Drainage by double J catheter at the end of the procedure was performed in all our patients. The length of hospitalization was 24 hours. Only one case of failure in the USSR was recorded, and one case of failure was in the semi-rigid URS. Conclusion: Laser ureteroscopy is an effective minimally invasive surgery in the management of lithiasis of the upper urinary tract. It significantly reduces the length of hospitalization. Mastery of this technique and the acquisition of the equipment necessary for its implementation is an undeniable asset in the management of renal and ureteral lithiasis.

Comparison of combined laparoscopic ureterolithotomy and flexible ureteroscopy with percutaneous nephrolithotomy for removing large impacted upper ureteral stones with concurrent renal stones

Objectives:The present study compared the safety and efficacy of combined laparoscopic ureterolithotomy(LU)and flexible ureteroscopy with percutaneous nephrolithotomy(PCNL)for removing large impacted upper ureteral stones with concurrent renal stones.Methods:This study included 52 patients who underwent combined LU and retrograde flexible ureteroscopy for removing renal stones(group A)or PCNL(group B)for removing large upper impacted ureteral stones and concurrent renal stones at our department from January 2014 to December 2016.Patient demographics,stone characteristics,and procedure-related parameters including stone-free rate,operation time,hospital stay after surgery,mean decrease in hemoglobin levels,visual analog scale(VAS)score,auxiliary procedure rate,and complication rate were compared between groups A and B.Results:Results of this study showed that both procedures were effective for removing large impacted upper ureteral stones with concurrent renal stones.The stone-free rate after a single procedure was 95.7%in group A and 89.7%in group B(p?0.62).The operation time was longer in group A than in group B(112.2±23.3 min versus 96.2±16.4 min,p?0.006).However,no significant difference was observed between the two groups with respect to the length of hospital stay after the surgery(5 days versus 6 days,p?0.06).The decrease in hemoglobin levels was significantly higher in group B than in group A(0.64±0.36 g/dL versus1.44±0.65 g/dL,p<0.0001).The mean VAS scores obtained at 24 hours(2.91±1.08 versus 5.10±1.01,p<0.0001)and 48 hours after the surgery(1.09±0.73 versus 2.28±0.96,p<0.0001)were significantly higher for group B than for group A.Moreover,the auxiliary procedure rate was higher in group B than in group A(6.9%versus 0%).Conclusion:These results indicate that both combined LU and flexible ureteroscopy and PCNL are suitable for removing large impacted upper ureteral stones with concurrent renal stones and are associated with a high rate of patients being stone free afterwards.Despite the longer operation time,the combined laparoscopic and endourological procedure may be associated with less postoperative pain and fewer major complications.However,the choice of treatment depends on the preferences of surgeons and patients.

Clinical efficacy and safety of flexible ureteroscopy and percutaneous nephrolithotomy for large kidney stones:A retrospective comparative study

BACKGROUND Renal stones ranging 20–40 mm are very common in China.Although no largesample clinical studies have confirmed the clinical efficacy and safety of this method,there is also a lack of comparative data with traditional treatment.AIM To investigate the clinical efficacy of flexible ureteroscopy(FURS)and percutaneous nephrolithotomy(PCNL)by postoperative stone clearance and changes in soluble vascular cell adhesion molecule 1(sVCAM-1)and kidney injury molecule 1(KIM-1)levels in patients with large kidney stones(>2 cm in diameter).METHODS This single-center observational study was performed at a Chinese hospital between January 1,2021,and October 30,2023.All 250 enrolled patients were diagnosed with large kidney stones(>2 cm)and divided into a FURS group(n=145)and a PCNL group(n=105)by the surgical method.The FURS group was treated with flexible ureteroscopy and the PCNL group was treated with percutaneous nephrolithotomy.The operation time,time to palinesthesia,intraoperative blood loss,drop in hemoglobin,length of hospital stay,stone clearance rate,and complications were recorded in the two groups.Preoperative and postoperative serum sVCAM-1 levels,erythrocyte sedimentation rate(ESR),urine KIM-1 levels,preoperative and postoperative pain visual analog scale(VAS)and Wisconsin Stone Quality of Life Questionnaire(WISQOL)scores were also documented.RESULTS All 250 eligible patients completed the follow-up.There were no significant differences in baseline characteristics between the two groups(P>0.05).The operation time in the FURS group was significantly greater than that in the PCNL group.The time to ambulation,intraoperative blood loss,decrease in hemoglobin,and length of hospital stay were significantly lower in the FURS group than in the PCNL group.The FURS group also had a significantly higher stone clearance rate and a lower incidence of postoperative complications.There was no significant difference in antibiotic use between the groups.Postoperative serum sVCAM-1 levels,urine KIM-1 levels,and VAS scores were lower in the FURS group than in the PCNL group,but postoperative ESR and WISQOL scores were greater in the FURS group than in the PCNL group.CONCLUSION FURS demonstrated superior clinical efficacy in treating large kidney stones(>2 cm in diameter)compared PCNL.It not only improved the postoperative stone clearance rate and reduced complications and recovery time but also positively affected serum SCM-1,ESR,and urine KIM-1 levels,subsequent improvement of patient quality of life.

输尿管软镜与微通道经皮肾镜碎石术治疗老年患者2.0~3.0 cm非下盏肾结石的疗效比较

目的探讨一次性电子输尿管软镜治疗老年患者2.0~3.0 cm非下盏肾结石的疗效和安全性。方法2021年1月~2022年12月我院78例老年患者2.0~3.0 cm非下盏肾结石,按照术式分为FURL组[一次性电子输尿管软镜碎石术(flexible ureteroscope lithotripsy,FURL)42例]和MPCNL组[微通道经皮肾镜碎石术(minimally invasive percutaneous nephrolithotomy,MPCNL)36例],比较2组手术时间、碎石时间、术后血红蛋白下降值、术后疼痛视觉模拟评分(Visual Analogue Scale,VAS)、住院时间、术后1周和4周结石清除率(stone free rate,SFR)、二次治疗率和并发症发生率等。结果所有患者均顺利完成手术。FURL组血红蛋白下降值(4.4±1.6)g/L,显著低于MPCNL组(24.7±4.6)g/L(t=-25.342,P=0.000);FURL组术后疼痛VAS评分(1.6±0.4)分,显著低于MPCNL组(5.6±0.9)分(t=-25.642,P=0.000);FURL组碎石时间(82.5±10.2)min,明显长于MPCNL组(53.8±8.4)min(t=13.437,P=0.000);FURL组手术时间(98.3±12.5)min,与MPCNL组(96.7±11.8)min比较差异无统计学意义(t=0.555,P=0,581);FURL组住院时间(3.5±1.5)d,显著短于MPCNL组住院时间(8.6±1.7)d(t=-13.947,P=0.000)。FURL组并发症发生率26.2%(11/42),与MPCNL组27.8%(10/36)差异无显著性(χ^(2)=0.025,P=0.875)。FURL组二次治疗率19.0%(8/42),与MPCNL组11.1%(4/36)差异无显著性(χ^(2)=0.938,P=0.333)。FURL组术后1周SFR 54.8%(23/42),明显低于MPCNL组86.1%(31/36)(χ^(2)=8.943,P=0.003);FURL组术后4周SFR 90.5%(38/42),与MPCNL组91.7%(33/36)差异无显著性(χ^(2)=0.000,P=1.000)。结论一次性电子输尿管软镜治疗老年患者2.0~3.0 cm非下盏肾结石效果显著,具有创伤小、恢复快、出血少、并发症发生率低、住院时间短等优势,值得在临床上推广应用。

可弯曲负压鞘联合软镜治疗≤3 cm上尿路结石的临床研究

目的:比较可弯曲负压鞘与负压直鞘、普通直鞘联合输尿管软镜在≤3 cm上尿路结石治疗中的临床疗效与安全性。方法:回顾性分析2022年1月至2023年9月重庆医科大学附属第一医院及重庆市綦江区人民医院接受输尿管软镜钬激光碎石取石术的128例上尿路结石患者的临床资料,因使用输送鞘不同,将病例分为可弯曲负压鞘组(组1,n=61);负压直鞘组(组2,n=31);普通直鞘组(组3,n=36),普通直鞘组、负压直鞘组统称传统鞘组。比较3组患者基线数据和围手术期指标。结果:3组患者一般资料,包括:性别、年龄、体质指数(body mass index,BMI)、结石直径、结石类型及方位、术前是否留置输尿管支架、术前感染指标以及住院时间和术后血红蛋白下降值比较,差异均无统计学意义。结石直径≤3 cm,可弯曲鞘组清石率最高(91.80%vs.80.65%vs.72.22%),与普通直鞘组相比差异有统计学意义(91.80%vs.72.22%;χ^(2)=4.155,P=0.012);且其净石率最高,与传统鞘组相比差异有统计学意义(73.77%vs.41.94%vs.33.33%;χ^(2)=17.486,P<0.001)。当结石分层直径大于2 cm时,可弯曲负压鞘组比传统鞘组净石率高,差异有统计学意义(72.55%vs.36%vs.23.08%;χ^(2)=19.645,P<0.001)。当结石直径为<2 cm时,可弯曲鞘组的清石率(90.00%vs.83.33%vs.90.00%;χ^(2)=0.193,P>0.908)和净石率(80.00%vs.66.67%vs.60.00%;χ^(2)=0.963,P>0.618)较传统鞘组稍高,差异无统计学意义。可弯鞘组的手术时间更长、住院总费用更低、并发症发生率更低。结论:可弯曲负压鞘可带来更高的即刻清石率、净石率以及更低的术后感染风险,同时减少了取石网篮的使用,节约了住院费用。与传统鞘相比在治疗≤3 cm上尿路结石有更高的有效性及安全性,值得推广应用。

局麻下可弯曲负压鞘联合输尿管软镜治疗≥3 cm肾结石的有效性和安全性研究

目的:探讨局部麻醉下可弯曲负压鞘联合输尿管软镜治疗3.0 cm以上大负荷肾结石的有效性和安全性。方法:回顾性分析2023年1月至2023年12月于重庆医科大学附属第一医院泌尿外科局麻下完成的输尿管软镜钬激光碎石治疗的3.0 cm以上肾结石患者的临床资料,并分为可弯鞘组和传统鞘组,收集其一般资料,对比2组在围术期指标、术后并发症、手术效果等相关指标的差异。结果:共96例患者纳入研究,其中可弯曲鞘组44例,传统鞘组52例,2组患者的年龄、体质指数(body mass index,BMI)、结石负荷等一般资料2组间比较差异无统计学意义,可弯鞘组术后清石率(72.73%)明显高于传统鞘组(46.15%),P<0.05,而并发症发生率,如发热(2.27%)、石街形成(2.27%)明显低于传统鞘组(23.08%/17.31%),P<0.05,单次手术时间可弯鞘组[(126.20±21.45)min]与传统鞘组[(116.71±27.39)min]比较差异无统计学意义。结论:局麻下可弯曲负压鞘联合输尿管软镜治疗≥3 cm肾结石安全、有效,值得推广和应用。

伴上尿路结石的尿源性脓毒血症患者引流后早期或晚期行智能控压软镜碎石术的有效性和安全性

目的比较伴上尿路结石的尿源性脓毒血症患者引流后早期或晚期行智能控压软镜碎石术治疗的安全性和有效性。方法回顾性分析2022年5月—2023年5月于南通大学附属医院泌尿外科行智能控压软镜碎石术治疗的59例伴上尿路结石的尿源性脓毒血症患者的临床资料,根据一期引流减压至二期碎石治疗间隔时间分为早期碎石(≤1周)组(n=27)与晚期碎石(>1周)组(n=32),比较两组患者的基线资料、影像学资料、术中及术后资料。结果两组患者在结石清除率、总并发症发生率、高级别并发症发生率、碎石治疗后的住院时间、碎石治疗后的住院费用和总住院治疗费用方面比较,差异均无统计学意义(P>0.05)。结论采用智能控压软镜碎石术早期碎石(≤1周)和晚期碎石(>1周)治疗尿源性脓毒血症引流后的患者均安全有效。

输尿管硬镜联合软镜碎石取石术治疗老年输尿管结石的临床效果及术后发生全身炎症反应综合征的危险因素

目的探讨输尿管硬镜联合输尿管软镜碎石取石术(FURL)治疗老年输尿管结石(UC)的临床效果及术后全身炎症反应综合征(SIRS)发生的危险因素。方法选取2018年1月至2022年12月在郑州市第三人民医院接受治疗的老年UC患者共计200例,以随机数字表法分为研究组(n=100)与对照组(n=100),对照组采用半硬性输尿管镜治疗,研究组采用输尿管硬镜联合FURL治疗,对两组一期清石率、围手术期指标及排尿功能进行比较,并统计术后SIRS发生情况,进行单因素分析与多因素Logistic回归分析以明确术后SIRS发生的危险因素。结果研究组一期清石率较对照组更高,术中出血量更少,血尿持续时间更短,但手术时间、住院时间更长,差异均有统计学意义(P<0.05);与术后1个月相比,两组术后3个月最大尿流量(Qmax)增加,国际前列腺症状评分量表(IPSS)评分下降,差异均有统计学意义(P<0.05),且研究组术后1个月、3个月的Qmax较对照组更高,IPSS评分更低,差异均有统计学意义(P<0.05);100例患者中,10例发生SIRS,发生率为10.00%;发生组术前白细胞计数(WBC)≥10×10~9/L、术前因结石发热、术中尿液浑浊与脓苔的患者比例较未发生组更高,差异均有统计学意义(P<0.05);多因素Logistic回归分析结果显示,术前因结石发热(OR=4.213)、术前WBC≥10×10~9/L(OR=2.122)、术中尿液浑浊与脓苔(OR=3.616)是输尿管硬镜联合FURL术后SIRS发生的独立危险因素,差异有统计学意义(P<0.05)。结论输尿管硬镜联合FURL应用于老年UC患者中,能够促进一期清石率提高及术中出血量减少,缩短血尿持续时间,提高排尿功能,但会延长手术时间、住院时间;术前WBC≥10×10~9/L、术前因结石发热、术中尿液浑浊与脓苔均为术后SIRS发生的危险因素。

输尿管软镜与硬镜下钬激光碎石术治疗复杂性输尿管上段结石患者的效果比较

目的:比较输尿管软镜与硬镜下钬激光碎石术治疗复杂性输尿管上段结石患者的效果。方法:回顾性分析2021年7月至2023年2月该院收治的188例复杂性输尿管上段结石患者的临床资料,根据手术方法不同将其分为软镜组(n=94)和硬镜组(n=94)。软镜组给予输尿管软镜下钬激光碎石术治疗,硬镜组予以输尿管硬镜下钬激光碎石术治疗。比较两组围术期指标水平,手术前后氧化应激指标[皮质醇(Cor)、肾上腺素(E)、去甲肾上腺素(NE)]水平,以及并发症发生率。结果:软镜组手术时间、住院时间均短于硬镜组,术中出血量少于硬镜组,碎石成功率高于硬镜组,结石上移率低于硬镜组,差异均有统计学意义(P<0.05);术后3 d,两组E、NE、Cor水平均高于术前,但软镜组低于硬镜组,差异有统计学意义(P<0.05);软镜组并发症发生率为4.26%(4/94),低于硬镜组的12.77%(12/94),差异有统计学意义(P<0.05)。结论:输尿管软镜下钬激光碎石术治疗复杂性输尿管上段结石患者可提高碎石成功率,改善围术期指标水平,减轻机体氧化应激反应,降低结石上移率和并发症发生率,效果优于输尿管硬镜下钬激光碎石术治疗。

Outcomes of a non-randomised audit of single pigtail suture stents in urolithiasis management of Asian patients in Singapore

Objective:Double-J(DJ)ureteric stents are commonly placed perioperatively for semirigid or flexible ureteroscopic renal surgery.It is believed that lesser stent material within the bladder mitigates stent-related symptoms.This study aimed to evaluate the J-Fil ureteral stent,a single pigtail suture stent compared with conventional DJ stent in relation to stent symptoms in an Asian population undergoing ureterorenal intervention.Methods:Based on internal audit committee recommendation approval,the records of 50 patients retrieved,available data of 41 patients who were prospectively enrolled into two groups(Group 1[J-Fil stent group],n=21 and Group 2[DJ stent group],n=20)between August 2020 to January 2021,were analysed.Parameters compared were nature of procedure,stone location and size,ease of deployment or removal,and complications.A modified universal stent symptom questionnaire was used to assess morbidity of stent symptoms within 48 h of insertion and at removal.Results:Both groups had similar median age,distribution in male to female ratio,and stone size.The overall median universal stent symptom questionnaire score at insertion was similar for bladder pain,flank or loin pain,and quality of life between Group 1 and 2;however,at removal Group 1 fared significantly better than Group 2,especially for flank or loin pain and pain at voiding.Both groups had similar ease in insertion with no hospital readmissions.Conclusion:Our audit favoured the single pigtail suture stent in Asian ureters in mitigating stent-related issues.It showed a good safety profile with easy deployment and removal.It promises a new standard in stenting.

分期输尿管软镜钬激光碎石术治疗≥4 cm复杂性肾结石的回顾性研究(附389例报道)

目的:探讨分期输尿管软镜钬激光碎石术(flexible ureteroscopic holmium lithotripsy,FURL)治疗复杂性肾结石的安全性和有效性。方法:回顾性分析2013年1月至2023年12月海军军医大学附属特色医学中心泌尿外科收治的389例单侧大负荷肾结石(直径≥4 cm)患者,分期行输尿管软镜钬激光碎石手术,统计手术次数和时间、住院时间和费用、结石清除率、并发症发生率等;并发症包括发热、尿源性脓毒症(urosepsis)、严重出血和石街等。结果:所有患者都至少经历2次手术,其中22例患者经历3次手术;1期手术的平均手术时间为(84.60±21.34)min,2期手术的平均手术时间为(89.70±19.17)min,清石率为94.60%,3期手术的平均手术时间为(72.50±17.30)min,清石率为90.90%;有21人次出现发热,其中7例诊断为尿源性脓毒症;76人次出现石街;30人次出现肉眼明显血尿。结论:分期FURL治疗大负荷结石的方案是安全有效的,略高一些的治疗费用要得到患者理解和同意。

输尿管软镜与输尿管硬镜联合拦截网篮钬激光碎石术治疗输尿管上段结石的随机对照临床研究

目的:分析输尿管软镜钬激光碎石术与输尿管硬镜联合拦截网篮钬激光碎石术治疗输尿管上段结石的临床效果。方法:选取2021年10月至2023年4月上海中医药大学附属上海市中西医结合医院收治的直径>10 mm的输尿管上段结石92例,随机分入软镜组46例和硬镜组46例,软镜组接受输尿管软镜钬激光碎石术,硬镜组接受输尿管硬镜联合拦截网篮钬激光碎石术。将两组患者根据肾下极水平线分为上部、下部亚组,比较整体及亚组间的手术成功率、手术时间、严重并发症和1个月结石清除率、3个月结石清除率。结果:两组手术成功率比较:整体上软镜组(95.7%)明显高于硬镜组(80.4%);分亚组比较,软镜上部组(96.0%)明显高于硬镜上部组(70.8%),软镜下部组(95.2%)与硬镜下部组(90.9%)比较无统计学差异(P>0.05)。两组手术成功患者手术时间比较:整体及分亚组比较,软镜组均明显长于硬镜组(P均<0.05)。两组严重并发症比较:整体及分亚组比较,软镜组与硬镜组差异均无统计学意义(P>0.05)。两组1个月结石清除率比较:整体上软镜组(84.1%)与硬镜组(67.6%)差异无统计学意义(P>0.05);分亚组比较,软镜上部组(83.3%)明显高于硬镜上部组(52.9%),软镜下部组(85.0%)与硬镜下部组(80.0%)无统计学差异(P>0.05)。两组3个月结石清除率比较:整体及分亚组比较,软镜组与硬镜组均无统计学差异(P>0.05)。结论:输尿管软镜与输尿管硬镜钬激光碎石术均为相对安全的手术方式。对于肾下极水平以上的输尿管上段结石,软镜钬激光碎石术的手术成功率和1个月结石清除率高于输尿管硬镜联合拦截网篮碎石术,是该部位更优的手术方式。对于肾下极以下的输尿管上段结石,软镜碎石和硬镜联合拦截网篮碎石的手术效果无明显差异,但硬镜手术时间更短。

导引鞘在输尿管软镜治疗输尿管中上段嵌顿性结石中的作用

目的:探讨导引鞘在输尿管软镜治疗输尿管中上段嵌顿性结石中的作用。方法:本研究将南昌市第三医院2021年3月—2023年3月收治的输尿管中上段嵌顿性结石患者91例作为研究对象,对患者的治疗方法进行回顾性分析,并按治疗方式的不同分为导引鞘组46例,无导引鞘组45例。导引鞘组采用有导引鞘的输尿管软镜治疗,无导引鞘组用无导引鞘的输尿管软镜治疗。比较两组临床指征、手术并发症、输尿管损伤及疼痛评分。结果:两组手术时间、住院时间、术后结石清除率、手术成功率比较,差异均无统计学意义(P>0.05)。导引鞘组输尿管损伤率为10.87%,与无导引鞘组输尿管损伤率13.33%比较,差异无统计学意义(P>0.05)。两组术后各时段视觉模拟评分法(VAS)评分比较,差异均无统计学意义(P>0.05)。导引鞘组并发症发生率为8.70%,显著低于无导引鞘组的26.67%,差异有统计学意义(χ^(2)=3.904,P=0.048)。结论:有或没有导引鞘的输尿管软镜在输尿管中上段嵌顿性结石中的治疗临床效果并无显著差别,其中置入导引鞘不会增加输尿管损伤,同时对患者疼痛的加剧无影响,并且相较于无导引鞘,有导引鞘的治疗可显著降低术后并发症。

输尿管软镜联合柔性可弯曲输尿管导引鞘在肾结石患者中的应用

目的探讨输尿管软镜联合柔性可弯曲输尿管导引鞘在肾结石患者中的应用价值。方法选择2022年1月至12月赣南医学院第三附属医院收治的40例肾结石患者作研究对象,按照随机数字表法分为对照组和观察组,每组各20例。两组均行输尿管软镜碎石术,对照组采用非可弯曲输尿管导引鞘,观察组采用柔性可弯曲输尿管导引鞘。比较两组的结石清除率、手术指标、疼痛程度、负性情绪、生活质量、并发症发生率。结果观察组术后1d及术后1个月的结石清除率均高于对照组,差异有统计学意义(P<0.05)。观察组的手术时间短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。术前,两组患者的疼痛程度、负性情绪、生活质量评分比较,差异无统计学意义(P>0.05);观察组术后3d的疼痛视觉模拟评分法(VAS)评分低于对照组,术后1个月的抑郁自评量表(SDS)、焦虑自评量表(SAS)评分低于对照组,术后1个月的世界卫生组织生活质量测定量表简表(WHOQOL-BREF)中社会关系、生理健康、心理健康、周围环境维度评分均高于对照组,差异有统计学意义(P<0.05)。观察组的并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论输尿管软镜联合柔性可弯曲输尿管导引鞘较非可弯曲输尿管导引鞘在缩短手术时间、减少术中出血量等方面优势明显,利于提高结石清除率,降低并发症发生风险,减轻患者疼痛、负性情绪,改善生活质量。

输尿管软镜与可弯曲负压吸引鞘治疗结石梗阻合并感染的效果

目的:探讨肾盂输尿管软镜下前端可弯曲负压吸引鞘治疗结石梗阻合并感染的有效性和安全性。方法:选择2022年1月—2023年12月瑞金市人民医院收治的100例输尿管结石梗阻合并感染患者纳入研究,通过电脑随机编码的方法,分为对照组(n=50)和试验组(n=50)。对照组采用肾盂输尿管软镜结合普通软镜外鞘的治疗方案,试验组采用肾盂输尿管软镜联合前端可弯曲负压吸引鞘的治疗方案。比较两组患者临床疗效、一次性结石清除率、手术指标、术前1 d和术后2周的血清指标[降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)和C反应蛋白(CRP)]及治疗2周内的并发症发生情况。结果:试验组临床总有效率和一次性结石清除率均高于对照组,差异均有统计学意义(P<0.05)。试验组手术时间和住院时间均短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05)。术后2周两组患者的PCT、TNF-α和CRP水平均降低,且试验组均低于对照组,差异均有统计学意义(P<0.05)。术后2周内,试验组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:肾盂输尿管软镜联合前端可弯曲负压吸引鞘治疗结石梗阻合并感染的效果显著,具有较高的结石清除率和较低的并发症发生率。

输尿管硬镜联合输尿管软镜钬激光碎石术治疗复杂性输尿管上段结石的效果分析

目的:分析输尿管硬镜联合输尿管软镜钬激光碎石术治疗复杂性输尿管上段结石的效果。方法:选取2020年3月—2022年12月同济赤壁医院收治的70例复杂性输尿管上段结石患者作研究对象,采用随机数字表法分为对照组与观察组,各35例。对照组实施输尿管硬镜钬激光碎石术,观察组在对照组基础上联合输尿管软镜钬激光碎石术。比较两组围术期指标、炎性指标、并发症发生情况。结果:观察组手术时间长于对照组,碎石时间短于对照组,术中出血量少于对照组,下床活动时间早于对照组,差异有统计学意义(P<0.001)。术前,两组白细胞计数(WBC)、中性粒细胞计数(NE)、血清降钙素原(PCT)水平比较,差异无统计学意义(P>0.05);术后7 d,两组WBC、NE、PCT水平高于术前,但观察组低于对照组,差异有统计学意义(P<0.05)。观察组并发症总发生率低于对照组,差异有统计学意义(P=0.022)。结论:输尿管硬镜联合输尿管软镜钬激光碎石术治疗复杂性输尿管上段结石的效果显著,可缩短碎石时间,减少术中出血量,减轻炎性反应,促进患者术后恢复,减少术后并发症。

末端可弯曲负压吸引鞘联合输尿管软镜治疗复杂肾结石的效果

目的:分析末端可弯曲负压吸引鞘联合输尿管软镜治疗复杂肾结石的效果。方法:选取2023年5—12月贵阳结石病医院收治的90例复杂肾结石患者作为研究对象,随机将患者分为对照组与观察组,各45例。对照组行普通镜鞘联合输尿管软镜治疗,观察组行末端可弯曲负压吸引鞘联合输尿管软镜治疗。比较两组围手术期指标、炎症因子水平、疼痛程度、舒适度及并发症。结果:观察组术中出血量少于对照组,手术时间长于对照组,住院时间、术后双J管留置时间短于对照组,结石清除率高于对照组,并发症发生率低于对照组,差异有统计学意义(P<0.05)。观察组术后次日降钙素原(PCT)、白细胞介素-6(IL-6)、C反应蛋白(CRP)水平低于对照组,差异有统计学意义(P<0.05)。观察组术后6 h、24 h视觉模拟评分法(VAS)评分低于对照组,Kolcaba舒适状况量表(GCQ)评分高于对照组,差异有统计学意义(P<0.05)。结论:末端可弯曲负压吸引鞘联合输尿管软镜治疗复杂肾结石减少术中出血量,缩短住院时间、术后带管时间,提高结石清除率,减轻机体炎症反应,缓解术后疼痛,提高舒适度。

纤维输尿管软镜联合钬激光治疗对肾结石患者结石清除率、炎症反应、肾功能的影响

目的探讨肾结石患者给予纤维输尿管软镜(FFU)联合钬激光治疗对结石清除率、炎症反应、肾功能及并发症的影响。方法选取2020年6月至2022年1月在唐河县卫生学校附属医院治疗的肾结石患者90例作为研究对象,按照随机数表法分成研究组(45例)和对照组(45例),对照组采用经皮肾镜碎石术(PCNL)治疗,研究组给予FFU与钬激光联合治疗,比较两组患者结石清除率、炎症反应、肾功能及术后并发症。结果研究组结石清除率较对照组更高,差异具有统计学意义(P<0.05);与同组术前相比,两组术后24 h白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、白细胞(WBC)、C反应蛋白(CRP)水平提高,差异均有统计学意义(P<0.05),但研究组水平较对照组更低,差异均有统计学意义(P<0.05);与同组术前相比,两组术后24h中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿素氮(BUN)、胱抑素C(CysC)、肾损伤因子-1(KIM-1)、肌酐(Cr)水平提高,差异均有统计学意义(P<0.05),但研究组水平较对照组更低,差异均有统计学意义(P<0.05);研究组术后并发症发生率较对照组更低,差异具有统计学意义(P<0.05)。结论肾结石患者给予FFU联合钬激光治疗能够提高结石清除率,减轻对炎症反应及肾功能的影响,减少术后并发症。