经尿道输尿管镜钬激光碎石术治疗输尿管结石的效果探讨  

Effect of transurethral ureteroscopic holmium laser lithotripsy on ureteral calculi

作　　者：隋振宇 陈志强 候晓莹 何莎莎 于淼[1] SUI Zhen-yu;CHEN Zhi-qiang;HOU Xiao-ying(Department of Urology Surgery,The 966th Hospital of the PLA Joint Logistic Support Force,Dandong 118100,China)

机构地区：[1]中国人民解放军联勤保障部队第九六六医院泌尿外科,118100

出　　处：《中国实用医药》2024年第22期64-67,共4页China Practical Medicine

摘　　要：目的 探讨输尿管结石经尿道输尿管镜钬激光碎石术治疗的效果。方法 选取62例输尿管结石患者,根据治疗方法不同分为钬激光碎石术组和冲击波碎石术组,各31例。钬激光碎石术组采用经尿道输尿管镜钬激光碎石术治疗,冲击波碎石术组采用体外冲击波碎石术治疗。比较两组围术期指标、碎石效果、临床疗效、炎性应激指标、创伤应激指标、肾功能指标及术后并发症发生情况。结果 钬激光碎石术组患者的术中失血量(10.86±1.45)ml少于冲击波碎石术组的(13.40±1.22)ml,手术时间(61.26±5.90)min、肠功能恢复时间(13.25±2.17)h、血尿时间(2.73±0.40)d、下床活动时间(3.18±1.07)d、住院时间(5.03±1.01)d均短于冲击波碎石术组的(70.57±6.03)min、(17.48±2.34)h、(4.54±1.60)d、(4.74±1.15)d、(6.40±1.32)d(P<0.05)。钬激光碎石术组患者的碎石成功率93.55%、结石排空率96.77%均高于冲击波碎石术组的74.19%、80.65%,术后止痛药应用占比16.13%低于冲击波碎石术组的51.61%(P<0.05)。钬激光碎石术组患者的总有效率93.55%高于冲击波碎石术组的70.97%(P<0.05)。手术后,两组患者的肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、去甲肾上腺素(NE)、醛固酮(ALD)、皮质醇(COR)水平均高于手术前,尿素氮(BUN)、血肌酐(SCr)水平均低于手术前(P<0.05),但两组患者的TNF-α、IL-1β、IL-6、NE、ALD、COR水平组间比较差异均不显著(P>0.05),钬激光碎石术组患者的BUN、SCr水平均低于冲击波碎石术组(P<0.05)。钬激光碎石术组患者的术后并发症发生率6.45%低于冲击波碎石术组的29.03%(P<0.05)。结论 输尿管结石采用经尿道输尿管镜钬激光碎石术治疗的效果较好。Objective To explore the effect of transurethral ureteroscopic holmium laser lithotripsy on ureteral calculi.Methods 62 patients with ureteral calculi were selected and divided into holmium laser lithotripsy group and shock wave lithotripsy group according to different treatment methods,each with 31 cases.The holmium laser lithotripsy group was given transurethral ureteroscopic holmium laser lithotripsy,and the shock wave lithotripsy group was given extracorporeal shock wave lithotripsy.The perioperative indicators,lithotripsy effect,clinical efficacy,inflammatory stress indicators,traumatic stress indicators,renal function indicators and postoperative complications were compared between the two groups.Results The intraoperative blood loss of(10.86±1.45) ml in holmium laser lithotripsy group was less than(13.40±1.22) ml in shock wave lithotripsy group;in holmium laser lithotripsy group,the operation time was(61.26±5.90) min,the intestinal function recovery time was(13.25±2.17) h,the hematuria time was(2.73±0.40) d,the ambulation time was(3.18±1.07) d,and the hospitalization time was(5.03±1.01) d,which were shorter than(70.57±6.03) min,(17.48±2.34) h,(4.54±1.60) d,(4.74±1.15) d,and(6.40±1.32) d in shock wave lithotripsy group(P<0.05).In holmium laser lithotripsy group,the success rate of lithotripsy was 93.55% and the stone clearance rate was 96.77%,which were higher than 74.19% and 80.65% in shock wave lithotripsy group;the percentage of postoperative painkillers was 16.13%,which was lower than 51.61% in shock wave lithotripsy group(P<0.05).The total effective rate of 93.55% in holmium laser lithotripsy group was higher than 70.97% in shock wave lithotripsy group(P<0.05).After surgery,the levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-6(IL-6),norepinephrine(NE),aldosterone(ALD),and cortisol(COR) in both groups were higher than those before surgery,and the levels of blood urea nitrogen(BUN),and serum creatinine(SCr) were lower than those before surgery(P<0.05).However,th

关 键 词：输尿管结石 经尿道输尿管镜钬激光碎石术 体外冲击波碎石术 肾功能 

分 类 号：R699.4[医药卫生—泌尿科学]