一期输尿管软镜钬激光碎石术联合可弯曲负压吸引鞘治疗>2 cm肾结石合并尿路感染的疗效观察  

Efficacy of primary flexible ureteroscopic holmium laser lithotripsy combined with flexible negative pressure suction sheath in the treatment of kidney stones >2 cm associated with urinary tract infection

作　　者：刘辉 魏勇 高海峰[1] 钱世磊 李希 刘威[2] 沈露明 朱清毅 胡海斌 LIU Hui;WEI Yong;GAO Haifeng;QIAN Shilei;LI Xi;LIU Wei;SHEN Luming;ZHU Qingyi;HU Haibin(Department of Urology,Binhai County People's Hospital,Yancheng,Jiangsu,224599,China;Department of Urology,the Second Affiliated Hospital of Nanjing Medical University)

机构地区：[1]滨海县人民医院泌尿外科,江苏盐城224599 [2]南京医科大学第二附属医院泌尿外科

出　　处：《临床泌尿外科杂志》2025年第3期284-288,共5页Journal of Clinical Urology

摘　　要：目的:探究一期输尿管软镜钬激光碎石术(retrograde intrarenal surgery,RIRS)联合可弯曲负压吸引鞘治疗直径>2 cm的肾结石伴有尿路感染患者的疗效及安全性。方法:选择2022年1月1日—2023年12月31日在南京医科大学第二附属医院和滨海县人民医院泌尿外科诊治的肾结石合并尿路感染患者150例,全部患者的结石直径均>2 cm,根据手术方法将患者分为2组,其中对照组采用RIRS治疗,观察组患者采用RIRS联合可弯曲负压吸引鞘治疗。对比2组的围术期手术、术后康复指标等。结果:观察组患者的术后结石清除率高于对照组,且尿路感染相关并发症发生率、发热概率均低于对照组(P<0.05);在围手术期指标的比较上,观察组手术时间、术后住院时间、术中出血量均低于对照组(P<0.05);在炎症反应指标比较上,观察组术后1 d的降钙素原水平、血白细胞计数、尿白细胞计数均低于对照组(P<0.05)。结论:对于直径>2 cm的肾结石合并尿路感染患者采用一期RIRS联合可弯曲负压吸引鞘能促进结石清除,并有助于缓解炎症反应,加速术后康复,值得推广。Objective:To investigate the efficacy and safety of single-stage retrograde intrarenal surgery(RIRS) with holmium laser lithotripsy combined with a flexible negative pressure ureteral access sheath(NPUAS) in the treatment of kidney stones larger than 2 cm in diameter accompanied by urinary tract infections.Methods:A total of 150 patients with kidney stones larger than 2 cm in diameter and urinary tract infections,treated between January 1st,2022,and December 31st,2023,at the Urology Department of the Second Affiliated Hospital of Nanjing Medical University and Binhai County People's Hospital,were selected.The patients were retrospectively divided into two groups based on their surgical method.The control group underwent RIRS with holmium laser lithotripsy,while the observation group used a flexible NPUAS during RIRS.Perioperative surgical outcomes and postoperative recovery indicators were collected and compared between the two groups.Results:The observation group had a higher postoperative stone clearance rate than the control group,and lower rates of urinary tract infection-related complications and fever(P<0.05).In comparison of perioperative indicators,the observation group had shorter operation time,shorter postoperative hospital stays,and less intraoperative blood loss than the control group(P<0.05).Additionally,the inflammatory response indicators(procalcitonin levels,blood leukocyte count,and urine leukocyte count on the first postoperative day) were lower in the observation group compared to the control group(P<0.05).Conclusion:For patients with kidney stones larger than 2 cm in diameter accompanied by urinary tract infections,single-stage RIRS combined with a flexible NPUAS can promote stone clearance,help alleviate the inflammatory response,and accelerate postoperative recovery,making it a procedure worth promoting.

关 键 词：肾结石 尿路感染 输尿管软镜钬激光碎石术 可弯曲负压吸引鞘 炎症反应 结石清除率 

分 类 号：R692.4[医药卫生—泌尿科学]