双镜联合治疗肾结石或输尿管上段结石的疗效分析  

Analysis of the curative effect of combined treatment of renal calculi or upper ureteral calculi with double endoscopy

作　　者：蔡嘉辉 农光任 李鸿海 卢保德 黄勇平[1] CAI Jiahui;NONG Guangren;LI Honghai;LU Baode;HUANG Yongping(Department of Urology Surgery,Affiliated Hospital of Youjiang Medical University for Nationalities,Baise 533000,Guangxi,China;Graduate School of Youjiang Medical University for Nationalities,Baise 533000,Guangxi,China)

机构地区：[1]右江民族医学院附属医院泌尿外科,广西百色533000 [2]右江民族医学院研究生学院,广西百色533000

出　　处：《中国现代医生》2024年第32期34-37,81,共5页China Modern Doctor

基　　金：广西壮族自治区百色市科学研究与技术开发计划项目(百科20184709);广西临床重点专科建设项目(2022021)。

摘　　要：目的探讨负压组合式输尿管镜联合输尿管软镜钬激光碎石治疗最大径为2~4cm肾结石或输尿管上段结石的疗效。方法收集右江民族医学院附属医院2023年3月至2024年3月住院治疗的最大径为2~4cm的肾结石或输尿管上段结石80例患者的病历资料,分为观察组(n=40)和对照组(n=40),观察组患者采用负压组合式输尿管镜联合输尿管软镜钬激光碎石,对照组患者行经皮肾镜碎石术(percutaneous nephrostolithotomy,PCNL)。比较两组患者的手术时间、术后住院时间、手术前后血常规白细胞计数(white blood cell,WBC)变化情况、手术前后尿常规WBC变化情况、术后疼痛视觉模拟评分(visual analogue score,VAS)、一期结石清除率及术后并发症发生情况等指标。结果观察组患者术后VAS评分及术后住院时间低于对照组(P<0.05),两组患者的手术时间、一期结石清除率、术后血常规WBC、术后尿常规WBC比较,差异无统计学意义(P>0.05),但两组患者手术后血常规WBC均较术前增高(P<0.05)。两组患者的结石清除率差异无统计学意义(P>0.05)。结论负压组合式输尿管镜联合输尿管软镜钬激光碎石治疗最大径为2~4cm肾结石或输尿管上段结石安全有效,有望部分替代PCNL,成为治疗最大径为2~4cm肾结石或输尿管上段结石的另一种安全可靠的术式。Objective To investigate the efficacy of negative pressure combined ureteroscopy combined with flexible ureteroscopy holmium laser lithotripsy in the treatment of renal calculi or upper ureteral calculi with a maximum diameter of 2-4cm.Methods The data of patients with renal calculi or upper ureteral calculi with a maximum diameter of 2-4cm who were hospitalized inAffiliated Hospital of Youjiang Medical University for Nationalities from March 2023 to March 2024 were collected and divided into observation group(n=40)and control group(n=40).The observation group was treated with negative pressure combined ureteroscopy combined with flexible ureteroscopy for holmium laser lithotripsy,and control group was treated with nephroscope for percutaneous nephrolithotomy(PCNL).The operation time,postoperative hospital stay,changes of blood routine white blood cell(WBC)before and after operation,changes of urine routine WBC before and after operation,postoperative visual analogue score(VAS),one-stage stone clearance rate and postoperative complications were compared between two groups.Results The postoperative hospitalization time and VAS of observation group were significantly lower than those of control group(P<0.05).There was no significant difference in operation time,stone clearance rate,postoperative blood routine WBC and postoperative urine routine WBC between two groups(P>0.05).However,the blood routine WBC of two groups after operation was higher than that before operation(P<0.05).The overall stone clearance rate of two surgical methods was 86.25%,of which the stone clearance rate of observation group was 82.5%,and control group was 90%.There was no significant difference between two groups(P>0.05).Conclusion It is safe and effective to treat renal calculi;or upper ureteral calculi with a maximum diameter of 2-4cm by negative pressure combined ureteroscopy combined with flexible ureteroscopy holmium laser lithotripsy.It is expected to partially replace PCNL and become another safe and reliable operation for the treat

关 键 词：负压组合式输尿管镜 输尿管软镜 肾结石 钬激光碎石 

分 类 号：R692.4[医药卫生—泌尿科学]