软性与硬性输尿管镜钬激光碎石术治疗输尿管结石伴输尿管狭窄疗效比较  

Comparison of the effect of holmium laser lithotripsy under flexible and rigid ureteroscope in the treatment of ureteral calculus combined with ureteric stenosis

作　　者：刘彦军[1] 景治安[1] 毛长青[1] 李纪华[1] 胡和平[1] LIU Yanjun;JING Zhian;MAO Changqing;LI Jihua;HU Heping(Department of Urology,Zhengzhou First People′s Hospital,Zhengzhou 450004,Henan Province,China)

机构地区：[1]郑州市第一人民医院泌尿外科,河南郑州450004

出　　处：《新乡医学院学报》2020年第10期976-979,共4页Journal of Xinxiang Medical University

摘　　要：目的比较软性与硬性输尿管镜钬激光碎石术治疗输尿管结石伴输尿管狭窄的临床效果。方法选择2016年9月至2017年11月郑州市第一人民医院收治的65例输尿管结石伴输尿管狭窄患者为研究对象,按照治疗方式将患者分为软性输尿管镜组(n=45)和硬性输尿管镜组(n=20)。硬性输尿管镜组患者行硬性输尿管镜钬激光碎石术,软性输尿管镜组患者行软性输尿管镜钬激光碎石术。观察2组患者手术时间、住院时间、结石排出情况及术后并发症,分别于术前及术后第1、3、5天检测患者血清肿瘤坏死因子-α(TNF-α)和白细胞介素-10(IL-10)水平。结果软性输尿管镜组患者的手术时间和住院时间分别为(39.5±0.8)min、(7.2±1.2)d,硬性输尿管镜组患者的手术时间和住院时间分别为(57.1±2.3)min、(7.9±0.8)d;软性输尿管镜组患者的手术时间显著短于硬性输尿管镜组(P<0.05),2组患者的住院时间比较差异无统计学意义(P>0.05)。软性输尿管镜组和硬性输尿管镜组患者结石排尽率分别为93.3%(42/45)、90.0%(18/20),2组患者的结石排尽率比较差异无统计学意义(χ^2=0.002,P>0.05)。术前2组患者血清TNF-α、IL-10水平比较差异无统计学意义(P>0.05);2组患者术后第1天血清TNF-α、IL-10水平显著高于术前,术后第3、5天血清TNF-α、IL-10水平显著低于术后第1天,术后第5天血清TNF-α、IL-10水平显著低于术后第3天(P<0.05);术后第1、3、5天,软性输尿管镜组患者血清TNF-α、IL-10水平显著低于硬性输尿管镜组(P<0.05)。软性输尿管镜组和硬性输尿管镜组患者术后并发症发生率分别为4.44%(2/45)、15.00%(3/20),软性输尿管镜组患者术后并发症发生率显著低于硬性输尿管镜组(χ^2=6.163,P<0.05)。结论软性和硬性输尿管镜钬激光碎石术治疗输尿管结石伴输尿管狭窄均可获得较高的结石排尽率,但软性输尿管镜钬激光碎石术手术时间短,可减轻机体炎症反应Objective To compare the clinical effect of holmium laser lithotripsy under flexible and rigid ureteroscope in the treatment of ureteral calculus combined with ureteric stenosis.Methods Sixty-five patients with ureteral calculus combined with ureteric stenosis admitted to Zhengzhou First People′s Hospital from September 2016 to November 2017 were selected as the research subjects,and the patients were divided into flexible ureteroscope group(n=45)and rigid ureteroscope group(n=20)according to the treatment methods.The patients in the rigid ureteroscope group were treated with holmium laser lithotripsy under rigid ureteroscopy,and the patients in the flexible ureteroscope group were treated with holmium laser lithotripsy under flexible ureteroscopy.The operation time,hospitalization time,stone discharge and postoperative complications were observed.The levels of serum tumor necrosis factor-α(TNF-α)and interleukin-10(IL-10)were measured before operation and on the first,third and fifth day after operation.Results The operation time and the hospitalization time in the flexible ureteroscope group were(39.5±0.8)min and(7.2±1.2)d,respectively.The operation time and the hospitalization time in the rigid ureteroscope group were(57.1±2.3)min and(7.9±0.8)d,respectively.The operation time in the flexible ureteroscope group was significantly shorter than that in the rigid ureteroscope group(P<0.05),and there was no significant difference in the hospitalization time between the two groups(P>0.05).The stone clearance rate in the flexible ureteroscope group and rigid ureteroscope group was 93.3%(42/45)and 90%(18/20),respectively.There was no significant difference in stone clearance rate between the two groups(χ^2=0.002,P>0.05).There was no significant difference in serum TNF-α and IL-10 levels between the two groups before operation(P>0.05).In the two groups,the levels of serum TNF-α and IL-10 on the first day after operation were significantly higher than those before operation,the levels of serum TNF-α and IL-10

关 键 词：软性输尿管镜 硬性输尿管镜 钬激光碎石术 输尿管结石 输尿管狭窄 

分 类 号：R691.4[医药卫生—泌尿科学]