可弯曲负压吸引鞘联合输尿管软镜钬激光碎石术治疗直径2~3 cm上尿路结石的临床研究

吴小将; 田文俊; 郑达闻; 郑枫

doi:10.16766/j.cnki.issn.1674-4152.003159

可弯曲负压吸引鞘联合输尿管软镜钬激光碎石术治疗直径2~3 cm上尿路结石的临床研究

doi: 10.16766/j.cnki.issn.1674-4152.003159

浙江大学附属第一医院浦江分院浦江县人民医院泌尿外科，浙江金华 322200

基金项目:

浙江省医药卫生科技计划项目 2023XY070

详细信息

通讯作者:
吴小将，E-mail: 81208747@qq.com

中图分类号: R692.4 R693.4
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出版历程
- 收稿日期: 2023-04-28
- 网络出版日期: 2023-10-19

Study on the treatment of upper urinary tract stones 2-3 cm in diameter using a flexible negative pressure suction sheath combined with flexible ureterorenoscopy holmium lithotripsy

Department of Urology, Pujiang County People' s Hospital, Jinhua, Zhejiang 322200, China

摘要

摘要: 目的探索将可弯曲负压吸引鞘与输尿管软镜钬激光碎石术(FURL)相结合用于治疗直径2~3 cm上尿路结石的临床效果和安全性，以期拓展FURL的适用范围。方法选择2019年3月—2022年9月浦江县人民医院收治的168例上尿路结石(直径2~3 cm)患者为研究对象，采用随机数字表法分为研究组(84例)和对照组(84例)，研究组实施可弯曲负压吸引鞘联合FURL，对照组实施经皮肾镜取石术(PCNL)。记录患者手术指标，统计结石清除率，检测手术前后血清炎症因子、应激反应因子和肾功能指标水平，随访术后并发症情况。结果研究组手术时长、尿液转清时间、首次下床时间和住院时间[(64.75±5.62)min、(2.53±0.36)d、(1.81±0.32)d、(7.25±0.86)d]均短于对照组[(73.84±5.93)min、(3.29±0.41)d、(2.47±0.39)d、(9.48±1.07)d，均P＜0.05]。2组结石清除率[94.05%(79/84) vs. 97.62%(82/84)]差异无统计学意义(P＞0.05)。研究组术后3 d血清炎症因子[肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和白细胞介素-8(IL-8)]、应激反应因子[去甲肾上腺素(NE)和皮质醇(Cor)]和肾功能指标[尿素氮(BUN)、血肌酐(SCr)、尿酸(UA)、胱抑素C(Cys-C)]均低于对照组(均P＜0.05)。研究组术后并发症总体发生率低于对照组(P＜0.05)。结论可弯曲负压吸引鞘联合FURL用于治疗直径2~3 cm的上尿路结石，在有效清除结石的基础上，可以缩短手术时间，促进患者术后快速康复，减少医源性创伤，缓解炎症及应激反应，减少术后并发症。
- 可弯曲负压吸引鞘 /
- 上尿路结石 /
- 输尿管软镜 /
- 钬激光碎石术 /
- 经皮肾镜碎石术
Abstract: Objective To observe the clinical efficacy and safety of flexible negative pressure ureteral access sheath combined with flexible ureterorenoscopy holmium lithotripsy (FURL) for upper urinary tract calculi. Methods A total of 168 patients with upper urinary tract calculi (2 to 3 cm in diameter), who admitted to Pujiang People' s Hospital from March 2019 to September 2022, were selected as the research objects. They were divided into study group (84 cases) and control group (84 cases) by random number table method. The study group was treated with flexible negative pressure suction sheath combined with FURL, and the control group was treated with percutaneous holmium laser nephrolithotomy (PCNL). The operation duration, urine clearance time, first time out of bed, hospital stay and other surgical indicators were recorded, and the stone clearance rate was calculated, the levels of serum inflammatory factor, stress response factors and renal function index content were determined before and after operation, and the postoperative complications were observed. Results The study group had significantly shorter operative duration, urine clearance time, first time out of bed, and hospitalization time [(64.75±5.62) min, (2.53±0.36) d, (1.81±0.32) d, (7.25±0.86) d] compared to the control group [(73.84±5.93) min, (3.29±0.41) d, (2.47±0.39) d, (9.48±1.07) d, all P < 0.05]. There was no significant difference in stone clearance rate between the two groups [94.05% (79/84) vs. 97.62% (82/84), P > 0.05]. The levels of inflammatory factors [tumor necrosis factor-α (TNF-α), hypersensitive C-reactive protein (hs-CRP), IL-6 and IL-8], stress response factors [norepinephrine (NE), cortisol (Cor)] and renal function indicators [serum creatinine (SCr), blood urea nitrogen (BUN), uric acid (UA) and cystatin C (Cys-C)] were significantly lower than the control group 3 days after operation (all P < 0.05). The overall incidence of postoperative complications was significantly lower in the study group than that in the control group (P < 0.05). Conclusion The flexible negative pressure suction sheath combined with FURL can be used to treat upper urinary tract calculi with a diameter of 2-3 cm. On the basis of ensuring the effectiveness of stone removal, it can shorten the operation time, promote the rapid recovery of patients after operation, reduce iatrogenic trauma, reduce the degree of inflammation and stress reaction of patients, reduce postoperative complications.
- Flexible negative pressure ureteral access sheath /
- Upper urinary tract calculi /
- Flexible ureterorenoscopy /
- Holmium lithotripsy /
- Percutaneous nephrolithotripsy

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表 1 2组上尿路结石患者手术及疗效指标比较

Table 1. Comparison of operation and curative effect indexes in two groups of patients with upper urinary tract stones

组别	例数	手术时长(x±s，min)	尿液转清时间(x±s，d)	首次下床时间(x±s，d)	住院时间(x±s，d)	结石清除[例(%)]
研究组	84	64.75±5.62	2.53±0.36	1.81±0.32	7.25±0.86	79(94.05)
对照组	84	73.84±5.93	3.29±0.41	2.47±0.39	9.48±1.07	82(97.62)
统计量		11.824^a	13.652^a	12.704^a	16.539^a	0.596^b
P值		＜0.001	＜0.001	＜0.001	＜0.001	0.440
注：^a为t值，^b为χ²值。

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表 2 2组上尿路结石患者手术前后血清炎症因子水平比较(x±s)

Table 2. Comparison of serum inflammatory factors in two groups of patients with upper urinary tract stones before and after operation (x±s)

组别	例数	TNF-α(ng/mL)		hs-CRP(ng/mL)		IL-6(pg/mL)		IL-8(ng/mL)
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d	术前	术后3 d
研究组	84	14.62±1.83	21.85±2.29^a	11.49±1.47	15.27±1.86^a	257.18±13.94	316.52±19.83^a	1.28±0.16	1.43±0.18^a
对照组	84	15.17±1.91	26.96±2.52^a	11.36±1.42	19.94±2.05^a	254.63±14.28	352.66±21.72^a	1.26±0.14	1.75±0.19^a
t值		0.453	12.357	0.361	14.239	0.419	10.849	0.392	9.163
P值		0.649	＜0.001	0.732	＜0.001	0.685	＜0.001	0.604	＜0.001
注：与同组术前比较，^aP＜0.05。

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表 3 2组上尿路结石患者手术前后血清应激反应因子水平比较(x±s)

Table 3. Comparison of serum stress response factor levels in two groups of patients with upper urinary tract stones before and after operation(x±s)

组别	例数	NE(mg/mL)		Cor(pg/mL)
组别	例数	术前	术后3 d	术前	术后3 d
研究组	84	112.71±6.29	154.37±8.41^a	28.64±2.51	37.04±2.59^a
对照组	84	113.25±6.36	171.62±8.95^a	28.36±2.38	42.61±2.78^a
t值		0.341	12.846	0.423	13.519
P值		0.752	＜0.001	0.679	＜0.001
注：与同组术前比较，^aP＜0.05。

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表 4 2组上尿路结石患者手术前后肾功能指标比较(x±s)

Table 4. Comparison of renal function indexes in two groups of patients with upper urinary tract stones before and after operation

组别	例数	SCr(μmol/L)		BUN(mmol/L)		UA(μmol/L)		Cys-C(mg/L)
组别	例数	术前	术后3 d	术前	术后3 d	术前	术后3 d	术前	术后3 d
研究组	84	65.37±4.19	73.65±6.36^a	4.41±0.59	5.18±0.62^a	259.06±18.39	284.62±19.53^a	0.64±0.07	0.70±0.10^a
对照组	84	64.95±4.28	81.39±6.84^a	4.39±0.57	5.87±0.65^a	257.41±18.47	309.43±20.86^a	0.63±0.09	0.82±0.12^a
t值		0.421	7.653	0.314	5.847	0.407	6.942	0.264	6.195
P值		0.672	＜0.001	0.779	＜0.001	0.685	＜0.001	0.829	＜0.001
注：与同组术前比较，^aP＜0.05。

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表 5 2组上尿路结石患者术后并发症情况比较[例(%)]

Table 5. Comparison of postoperative complications of upper urinary tract stones in two groups[cases (%)]

组别	例数	发热	尿道感染	上尿路损伤	尿道迟发性出血	合计
研究组	84	5(5.95)	1(1.19)	2(2.38)	3(3.57)	11(13.10)
对照组	84	9(10.71)	3(3.57)	7(8.33)	5(5.95)	24(28.57)
注：2组并发症总发生率比较，χ²=6.099，P=0.014。

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