输尿管软镜取石术联合输尿管硬镜钬激光碎石术治疗2~4 cm肾下盏结石的疗效及并发症分析

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摘要 目的：观察输尿管软镜（FU）联合输尿管硬镜（RU）钬激光碎石术治疗2~4 cm肾下盏结石的疗效及并发症发生情况。方法：回顾性选取2021年8月―2022年8月在本院收治的100例肾下盏结石患者（结石大小2~4 cm）,根据患者治疗方案分为联合组（n=42）和输尿管软镜下钬激光碎石术（FURL）组（n=58）,联合组采用FU联合RU钬激光碎石术治疗,FURL组采用FURL术治疗。比较两组围术期相关指标、结石清除率、术前术后实验室指标[肾功能：血清胱抑素C（CysC）、同型半胱氨酸（HCY）及血清肌酐（Scr）;炎性反应：白细胞介素6（IL-6）、IL-10、C反应蛋白（CRP）]及并发症发生情况。结果：联合组手术时间及住院时间均较FURL组短,术中失血量少于FURL组。联合组结石清除率明显高于FURL组。术后,两组患者CysC、Hcy、Scr、IL-6、IL-10水平比较无差异;联合组患者CRP水平高于FURL组。两组患者术后并发症比较无明显差异。结论：对于2~4 cm的肾下盏结石,RU联合FURL治疗可提高临床结石清除率,缩短住院时间,且不会增加肾损伤及并发症风险;但仍存在损伤风险,需临床注意。

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	吴尔岸
	何庆华
	陆阳
	韦学东
	韦苏春

关键词 ：输尿管软镜, 输尿管硬镜, 钬激光碎石, 肾结石, 并发症

Abstract：Objective To observe the effect and complications of flexible ureteroscope (FU) combined with rigid ureteroscope (RU) for holmium laser lithotripsy in the treatment of 2-4 cm subrenal calyx calculi. Methods A total of 100 patients with renal stones (2-4 cm) admitted to the hospital were retrospectively enrolled between August 2021 and August 2022. According to different treatment methods, they were divided into combination group (n=42, FU combined with RU for holmium laser lithotripsy) and flexible ureteroscopic holmium lithotripsy (FURL) group (n=58, FURL). The perioperative related indexes, stone clearance rate, preoperative and postoperative laboratory indexes [renal function: serum cystatin C (CysC), homocysteine (HCY), serum creatinine (Scr); inflammatory response: interleukin-6(IL-6), IL-10, C-reactive protein (CRP) ] and complications in the two groups were compared. Results The operation time and hospitalization time in combination group were shorter than those in FURL group, and intraoperative blood loss was less than that in FURL group. The stone clearance rate in combination group was significantly higher than that in FURL group. After surgery, there was no difference in levels of CysC, Hcy, Scr, IL-6 and IL-10 between the two groups. CRP level in combination group was higher than that in FURL group. The difference in postoperative complications between the two groups was not statistically significant. Conclusion RU combined with FURL can increase clinical stone clearance rate and shorten hospitalization time in patients with 2-4 cm subrenal calyx calculi, which will not increase the risks of renal injury and complications. However, there is still injury risk, which needs clinical attention.

Key words： flexible ureteroscope rigid ureteroscope holmium laser lithotripsy renal stone complication

收稿日期: 2023-02-02

中图分类号:

R693

基金资助:广西壮族自治区卫生健康委员会自筹科研课题（Z-B20220930）

通讯作者: 吴尔岸,E-mail：wueran@126.com

引用本文:

吴尔岸, 何庆华, 陆阳, 韦学东, 韦苏春. 输尿管软镜取石术联合输尿管硬镜钬激光碎石术治疗2~4 cm肾下盏结石的疗效及并发症分析[J]. 湖南师范大学学报(医学版), 2023, 20(2): 51-53. WU Er'an, HE Qinghua, LU Yang, WEI Xuedong, WEI Suchun. Effect and complications of flexible ureteroscope combined with rigid ureteroscope for holmium laser lithotripsy in the treatment of 2-4 cm subrenal calyx calculi. HuNan ShiFan DaXue XueBao(YiXueBan), 2023, 20(2): 51-53.

链接本文:

http://yxb.hunnu.edu.cn/CN/ 或 http://yxb.hunnu.edu.cn/CN/Y2023/V20/I2/51

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