摩西钬激光与传统钬激光在输尿管软镜碎石术中的疗效比较  

Comparative study on the efficacy of Moses holmium laser versus traditional holmium laser in the treatment of renal calculi under flexible ureteroscopic lithotripsy

作　　者：高超 杨永安[1] 马涛[1] 杨文增[1] 安丰[1] 崔振宇[1] 周洪月[1] 李昱[1] 杨伟东[1] Gao Chao;Yang Yongan;Ma Tao;Yang Wenzeng;An Feng;Cui Zhenyu;Zhou Hongyue;Li Yu;Yang Weidong(Department of Urology,Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]河北大学附属医院泌尿外科,保定071000

出　　处：《中华泌尿外科杂志》2024年第3期195-201,共7页Chinese Journal of Urology

基　　金：保定市科学技术和知识产权局指导项目(18ZF18)。

摘　　要：目的比较摩西钬激光与传统钬激光在输尿管软镜碎石术治疗肾结石中的疗效。方法回顾性分析2017年1月至2023年1月于河北大学附属医院接受输尿管软镜钬激光碎石术治疗的425例肾结石患者的临床资料。其中,136例采用传统钬激光进行碎石(普通组),289例应用摩西钬激光碎石(摩西组)。为减少由于非随机分配而产生的选择偏差,采用1:1倾向评分匹配(PSM),以保证两组患者的临床基线数据(年龄、性别)和结石特征(结石位置、数量、直径、CT值和结石成分)具有可比性。比较匹配后两组在手术时间、激光作用时间、结石清除率(SFR)、术后并发症和二次治疗方面的差异,并通过多因素logistic回归分析影响SFR的危险因素。进一步比较摩西组与普通组在处理直径≥20mm肾结石的疗效。结果经PSM匹配后,两组各纳人108例。匹配后普通组与摩西组年龄[57.0(49.0,65.0)岁与58.5(51.8,66.0)岁]、性别[男性:58.3%(63/108)与60.2%(65/108)、结石位置(上盏/中盏/下盏/肾孟:33/35/38/42例与35/33/40/42例)、多发结石比例[33.3%(36/108)与35.2%(38/108)]、结石直径[14.0(11.0,16.0)mm与14.0(12.0,17.0)mm]、结石CT值[1115.5(993.2,1228.2)HU与1114.5(1000.2,1216.5)HU]和含钙结石[83.3%(90/108)与79.6%(86/108)等均表现出良好的一致性(绝对标准化均值差异<0.1)。摩西组的手术时间短于普通组[48.5(36.0,56.0)min与60.0(48.8,68.0)min,P<0.01],术后SFR显著高于普通组[88.9%(96/108)与67.6(73/108),(P<0.01)],术后二次手术率更低[1.8%(2/108)与9.3%(10/108),P=0.04]。多因素logistic回归分析结果显示应用摩西钬激光(0R=0.029,P<0.01)、结石直径(OR=1.492P<0.01)、结石CT值(OR=1.007,P<0.01)、含钙结石(OR=1.551,P<0.01)、激光作用时间(OR=0.863,P<0.01)、术前留置双J管(OR=0.193,P<0.01)和术前存在中重度肾积水(OR=1.651,P<0.01)均是SFR的影响因素。在结石长径为20~30mm的患者中,摩西组较普通组的手术时间[50.5(43.8,58.3)min�Objective To compare the effectiveness of the Moses holmium laser and the traditional holmium laser in the treatment of kidney stones using flexible ureteroscopy.Methods The data of 425 patients with kidney stones treated with flexible ureteroscopic holmium laser lithotripsy at Hebei University Affiliated Hospital from January 2017 to January 2023 were retrospectively analysed.Among them,136 cases were treated with traditional holmium laser(traditional group),and 289 cases were treated with Moses holmium laser(Moses group).To minimize selection bias due to non-random allocation,1:1 propensity score matching(PSM)was employed,ensuring comparability between the two groups in baseline characteristics(age,gender)and stone characteristics(stone location,number,diameter,CT value,and stone composition).The differences in operation time,laser action time,stone clearance rate(SFR),postoperative complications and secondary treatment rate were compared between the two groups after matching.The risk factors affecting SFR were analyzed by multivariate logistic regression.The efficacy of Moses group and traditional group in treating kidney stones with diameter≥20 mm was also compared.Results After PSM,108 patients were selected from each group for data analysis.Traditional group and Moses group demonstrated good consistency in baseline characteristics,including age[57.0(49.0,65.0)years old vs.58.5(51.8,66.0)years old],male gender[58.3%(63/108)vs.60.2%(65/108)],stone location(upper calyx/mid calyx/lower calyx/pelvis:33/35/38/42 cases vs.35/33/40/42 cases),multiple stones[33.3%(36/108)vs.35.2%(38/108)],diameter[14.0(11.0,16.0)mm vs.14.0(12.0,17.0)mm],CT value[1115.5(993.2,1228.2)HU vs.1114.5(1000.2,1216.5)HU],and the presence of calcium stones[83.3%(90/108)vs.79.6%(86/108)],and all showing absolute standardized mean difference(ASMD)<0.1.The Moses group had shorter operation time[48.5(36.0,56.0)min vs.60.0(48.8,68.0)min,P<0.01],higher post-operative stone-free rate(SFR)[88.9%(96/108)vs.67.6(73/108),P<0.01],and lower rate of seco

关 键 词：肾结石 钬激光 摩西技术 结石清除率 输尿管软镜 倾向评分匹配 

分 类 号：R699.4[医药卫生—泌尿科学]