硕通镜联合输尿管软镜治疗2~3 cm肾下盏结石疗效  

Curative effect of Shuotong ureteroscopy combined with flexible ureteroscope in the treatment of 2-3 cm lower calyceal calculi

作　　者：梁意龙 邓婷 陈燊 唐梓严 李震[1] 何国友[1] 庞劲松 Liang Yilong;Deng Ting;Chen Shen;Tang Ziyan;Li Zhen;He Guoyou;Pang Jinsong(Department of Urology,the Second People′s Hospital of Yulin,Yulin 537000,China)

机构地区：[1]玉林市第二人民医院泌尿外科,玉林537000

出　　处：《国际外科学杂志》2024年第2期77-85,F0003,共10页International Journal of Surgery

摘　　要：目的探讨硕通镜联合输尿管软镜治疗2~3 cm肾下盏结石疗效及影响因素分析。方法回顾性选取2019年2月—2022年12月于玉林市第二人民医院接受治疗的肾下盏结石患者102例,根据治疗方法不同将其分为观察组和对照组,每组各51例。观察组患者采用硕通镜联合输尿管软镜治疗,对照组患者采用单纯输尿管软镜治疗。依据术后结石清除情况将患者分为结石未清除组(n=13)和结石清除组(n=89)。比较观察组和对照组患者的手术时间、住院时间、碎石时间、术中出血量、并发症发生率、结石清除率。广义估计方程分析评价治疗时间、治疗方法及两者的交互作用对视觉模拟评分(VAS)、白细胞(WBC)、血尿素氮(BUN)、血肌酐(Cr)、血红蛋白(HGB)、降钙素原(PCT)的影响。采用单因素及多因素Logistic回归分析评价影响一次性术后清石率的影响因素。基于危险因素构建列线图模型并对模型进行评价。结果与对照组相比,观察组患者的手术时间[(118.72±9.61) min比(136.65±11.27) min]、住院时间[(6.43±1.12) d比(10.29±2.23) d]及碎石时间[(51.23±10.38) min比(56.62±11.43) min]明显较短,术中出血量[(128.52±10.20) mL比(157.53±15.31) mL]明显较少,差异均具有统计学意义(P<0.05)。广义估计方程分析评价结果显示,治疗时间、治疗方法及两者的交互作用对WBC、HGB、BUN、Cr、PCT、VAS有明显影响(P<0.05)。与对照组比较,观察组患者的并发症发生率(5.88%比19.61%)明显降低,一次性术后清石率(94.12%比80.39%)明显增加,差异均具有统计学意义(P<0.05)。手术方式、下盏肾盂角(IPA)、肾盂下盏高度(CPH)、结石最大径均是2~3 cm肾下盏结石患者一次性术后清石率的影响因素(P<0.05)。本研究构建的列线图模型的区分度、校准度及临床实用性均较好,且可较好地识别2~3 cm肾下盏结石清除不彻底的高危患者。结论硕通镜联合输尿管软镜处理2~3 cm肾Objective To investigate the efficacy of Shuotong ureteroscope combined with flexible ureteroscope in the treatment of 2-3 cm lower calyceal calculi,and analyze the influencing factors.Methods A total of 102 patients with lower calyceal calculi were treated in the Second People′s Hospital of Yulin from February 2019 to December 2022,and they were divided into the observation group and the control group,with 51 cases in each group.The patients of the observation group were treated with Shuotong ureteroscope combined with flexible ureteroscope,while the patients of the control group were treated with flexible ureteroscope.According to whether the stones were completely removed after operation,all patients were divided into non-stone removal group(n=13)and stone removal group(n=89).The operation time,hospitalization time,lithotripsy time,intraoperative blood loss,complication rate and stone clearance rate were compared between the observation group and the control group.Generalized Estimation Equation was used to analyze and evaluate the effects of treatment time,treatment scheme and their interaction on visual analogue scale(VAS),white blood cell(WBC),blood urea nitrogen(BUN),blood creatinine(Cr),hemoglobin(HGB)and procalcitonin(PCT).Univariate and multivariate Logistic regression were used to analyze the risk factors of stone removal rate.Nomogram model was constructed based on risk factors and evaluate the model.Results Compared with the control group,operation time[(118.72±9.61)min vs(136.65±11.27)min],hospitalization stay[(6.43±1.12)d vs(10.29±2.23)d]and the lithotripsy time[(51.23±10.38)min vs(56.62±11.43)min]of the observation group were shorter,and the amount of intraoperative blood loss[(128.52±10.20)mL vs(157.53±15.31)mL]were significantly less than those of the control group(P<0.05).The results of Generalized Estimation Equation analysis showed that treatment time,treatment regimen and their interaction had significant effects on WBC,HGB,BUN,Cr,PCT and VAS(P<0.05).Compared with the control group

关 键 词：肾结石 危险因素 列线图 硕通镜 输尿管软镜 结石清除率 

分 类 号：R699.2[医药卫生—泌尿科学]