负压组合式输尿管硬镜联合输尿管软镜碎石术治疗体外碎石失败后肾盂或输尿管上段结石的临床研究  

Clinical study of negative pressure combined rigid ureteroscope combined with flexible ureteroscope in treatment of pyelon or upper ureter stones after extracorporeal lithotripsy failure

作　　者：张振丰 周晨龙[1] 王军[1] 段潇 杨超 ZHANG Zhen-feng;ZHOU Chen-long;WANG Jun;DUAN Xiao;YANG Chao(Department of Urology,Anyang People's Hospital,Anyang,Henan 455000,China)

机构地区：[1]安阳市人民医院泌尿外科,河南安阳455000

出　　处：《医药论坛杂志》2025年第1期60-65,共6页Journal of Medical Forum

摘　　要：目的探讨负压组合式输尿管硬镜联合输尿管软镜碎石术在肾盂或输尿管上段结石(直径≤2 cm)患者体外冲击波碎石术(extracorporeal shockwave lithotripsy,ESWL)治疗失败后的应用疗效。方法选取2022年10月—2023年10月安阳市人民医院收治的204例ESWL治疗失败后肾盂或输尿管上段结石患者为研究对象,且患者结石直径均≤2 cm,随机分为负压组合式硬镜联合输尿管软镜组(观察组102例)和微通道经皮肾镜组(对照组102例),比较两组的手术指标、结石清除率、并发症,以及手术前后两组的肾功能指标[血尿素氮(blood urea nitrogen,BUN)和血肌酐(serum creatinine,Scr)]、炎症因子变化。结果观察组手术时间明显长于对照组(P<0.05),住院时间、血红蛋白下降值、术后疼痛评分(visual analogue score,VAS)评分均小于对照组(P<0.05)。两组结石清除率,并发症发生情况的差异无统计学意义(P>0.05),术后观察组肾功能均低于对照组(P<0.05);观察组炎症因子低于对照组(P<0.05)。结论对于体外碎石失败后的肾盂或输尿管上段结石(直径≤2 cm),负压组合式输尿管硬镜联合输尿管软镜碎石可更明显的减轻疼痛,减少术中失血量,缩短住院时间,减轻炎症反应,改善肾功能。Objective To explore the therapeutic effect of negative pressure combination ureteroscopy combined with ureteroscopic lithotripsy in patients with renal pelvis or upper ureteral stones(diameter≤2 cm)after extracorporeal shockwave lithotripsy(ESWL)treatment failure.Methods Totally 204 patients with renal pelvis or upper ureteral stones after ESWL treatment failure admitted to the Anyang People's Hospital from October 2022 to October 2023 were selected as the study subjects,and the stone diameter of the patients was≤2 cm.They were randomly divided into a negative pressure combination hard mirror combined with ureteral soft mirror group(observation group of 102 cases)and a micro channel percutaneous nephroscope group(control group of 102 cases).The surgical indicators,stone clearance rate,complications,as well as renal function indicators[blood urea nitrogen(BUN),serum creatinine(Scr)],and changes in inflammatory factors before and after surgery were compared between the two groups.Results The surgical time in the observation group was significantly longer than that in the control group(P<0.05),and the hospital stay,hemoglobin decrease,and visual analogue score(VAS)score were all lower than those in the control group(P<0.05).The differences of stone clearance rate and incidence of complications in both groups were not statistically significant(P>0.05),and the renal function in the postoperative observation group was lower than that in the control group(P<0.05);the inflammatory factors in the observation group were lower than those in the control group(P<0.05).Conclusion For renal pelvis or upper ureteral stones(diameter≤2 cm)after failed extracorporeal lithotripsy,negative pressure combination ureteroscopy combined with ureteroscopy can significantly reduce pain,reduce intraoperative blood loss,shorten hospital stay,alleviate inflammatory reactions,and improve renal function.

关 键 词：输尿管硬镜 输尿管软镜 上段结石 肾功能指标 炎症因子 

分 类 号：R699.2[医药卫生—泌尿科学]