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

吴尔岸; 何庆华; 陆阳; 韦学东; 韦苏春

PDF(2270 KB)

湖南师范大学学报医学版 ›› 2023, Vol. 20 ›› Issue (2) : 51-53.

临床医学

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

吴尔岸, 何庆华, 陆阳, 韦学东, 韦苏春

作者信息 +

Effect and complications of flexible ureteroscope combined with rigid ureteroscope for holmium laser lithotripsy in the treatment of 2-4 cm subrenal calyx calculi

WU Er'an, HE Qinghua, LU Yang, WEI Xuedong, WEI Suchun

Author information +

文章历史 +

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。

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.

导出引用

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[J]. Journal of Hunan Normal University(Medical Science). 2023, 20(2): 51-53

中图分类号： R693

参考文献

[1] 朱澄村, 程帆, 饶婷, 等. 输尿管软镜碎石术治疗上尿路结石的疗效和安全性[J]. 中华泌尿外科杂志, 2020, 41(1): 41-45.
[2] Xu Y, Bai Z, Ma D, et al.Laparoscopic ureterolithotomy, flexible ureteroscopic lithotripsy and percutaneous nephrolithotomy for treatment of upper urinary calculi in patients with autosomal dominant polycystic kidney disease[J]. Clin Exp Nephrol, 2020, 24(9): 842-848.
[3] 张立进, 吴斌, 查振雷, 等. 后腹腔镜下输尿管切开取石术与输尿管软镜钬激光碎石术治疗复杂性上段输尿管结石的效果分析[J]. 中华外科杂志, 2017, 55(10): 751-754.
[4] 施华娟, 耿和, 吴宗林, 等. 输尿管软镜下钬激光碎石术治疗直径≤20 mm和>20 mm上尿路结石的疗效比较[J]. 现代泌尿外科杂志, 2017, 22(2): 123-127.
[5] 路通, 付天英, 高伟兴, 等. 输尿管软镜钬激光碎石治疗不同直径肾结石的疗效分析[J]. 华北理工大学学报 (医学版), 2019, 21(4): 274-278+284.
[6] 孙树欣, 程佳欢, 洪含霞. 输尿管硬镜或经皮肾镜取石术联合输尿管软镜取石术治疗输尿管上段嵌顿性结石效果比较[J]. 中国医学前沿杂志 (电子版), 2020, 12(12): 81-85.
[7] 刘金, 罗功唐, 刘元鹏. 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临床效果[J]. 国际泌尿系统杂志, 2021, 41(2): 305-308.
[8] Thongprayoon C, Krambeck AE, Rule AD.Determining the true burden of kidney stone disease[J]. Nat Rev Nephrol, 2020, 16(12): 736-746.
[9] Jiao B, Lai S, Xu X, et al.The efficacy of flexible ureteroscopy lithotripsy and miniaturized percutaneous nephrolithotomy for the treatment of renal and proximal ureteral calculi of ≤2 cm: A retrospective study[J]. Medicine (Baltimore), 2019, 98(11): 14535-14540.
[10] 颜春连, 万繁, 席翔, 等. 输尿管软镜下钬激光碎石术治疗小于2 cm肾结石的效果观察[J]. 微创泌尿外科杂志, 2020, 9(6): 380-385.
[11] 倪颖, 周金才, 王启明, 等. 硬镜联合软镜与单纯软镜下钬激光治疗肾盂出口及输尿管近端结石的比较研究[J]. 现代医学, 2020, 48(3): 345-347.
[12] 刘尚文, 王亚东, 林峰. 负压组合式硬输尿管镜联合输尿管软镜治疗直径>2 cm肾盂结石的临床效果[J]. 微创泌尿外科杂志, 2020, 9(6): 376-379.
[13] 钟思文, 杨建军, 李登宝, 等. 输尿管软镜取石术联合输尿管硬镜钬激光碎石术治疗肾结石的体会 (附42例报告)[J]. 泌尿外科杂志 (电子版), 2021, 13(3): 4-7.
[14] 吕锋, 严萌, 豆海锋. 组合式输尿管硬镜联合软镜治疗2~3 cm肾盂结石临床观察[J]. 海南医学, 2020, 31(6): 727-730.
[15] 王文涛, 简百录, 乔少谊, 等. 坦洛新对输尿管下段结石患者体外冲击波碎石术后排石及血清IL-6, IL-10和CRP水平的影响[J]. 现代生物医学进展, 2018, 18(21): 4099-4102.