一次性电子软镜和常规可重复性软镜对输尿管上段结石患者肾功能和创伤程度的影响及术后复发的危险因素研究

Research on the effect of disposable electronic soft mirror and conventional repeatable soft mirror on the renal function as well as trauma degree in patients with upper ureteral calculi and factors risk for postoperative recurrence

摘要:

目的 探讨一次性电子软镜和常规可重复性软镜对输尿管上段结石患者肾功能和血清前列腺素E2（PGE2）、5-羟色胺（5-HT）水平的影响，并分析输尿管软镜碎石术（RIRS）治疗输尿管上段结石术后复发的影响因素。方法 选取2022年3月－2023年3月该院收治的输尿管上段结石患者114例，按随机数表法分为观察组（n = 57）和对照组（n = 57）。观察组使用一次性电子输尿管软镜行RIRS治疗，对照组采用常规可重复性输尿管软镜行RIRS治疗，比较两组患者手术情况。于术前和术后24 h，检测患者肾功能指标［血尿素氮（BUN）、肌酐（Cr）、半胱氨酸蛋白酶抑制剂C（CysC）］、PGE2和5-HT水平。术后随访6个月，比较两组患者术后并发症和复发情况。根据术后有无复发进行分组，收集复发组和未复发组的病历资料，并对术后复发的危险因素进行统计分析。结果 观察组和对照组手术时间、术中出血量、一次性结石清除率和住院时间比较，差异均无统计学意义（P > 0.05）。两组患者术后血清BUN、Cr、CysC、PGE2和5-HT水平较术前明显升高，差异均有统计学意义（P < 0.05），但组间比较，差异均无统计学意义（P > 0.05）。观察组术后并发症总发生率和复发率分别为3.51%和15.79%，对照组分别为12.28%和21.05%，两组患者比较，差异均无统计学意义（P > 0.05）。复发组体重指数（BMI）、术后残留结石率和术后泌尿系感染率明显高于未复发组，差异均有统计学意义（P < 0.05）。多因素Logistic回归分析显示，在校正性别、年龄、病程、结石最大直径、结石数目、结石位置和手术方式等混杂因素后，术后残留结石和术后泌尿系感染是RIRS治疗输尿管上段结石术后复发的独立危险因素（P < 0.05）。结论 一次性电子软镜和常规可重复性软镜在输尿管上段结石的治疗中，均能取得满意疗效，这两种软镜均可对患者的肾功能、血清PGE2和5-HT水平产生一定影响，且术后均存在一定的复发风险。术后残留结石和术后泌尿系感染是RIRS治疗输尿管上段结石术后复发的独立危险因素。

Abstract:

Objective To explore the effect of disposable electronic soft mirror and conventional repeatable soft mirror on the renal function and prostaglandin E2 (PGE2), 5-hydroxytryptamine (5-HT) levels in patients with upper ureteral calculi and analyze the factors influencing recurrence after retrograde intrarenal surgery (RIRS).Methods 114 patients with upper ureteral calculi from March 2022 to March 2023 were selected and randomly divided into two groups, with 57 cases forming the observation group and 57 cases forming the control group. The observation group was administrated with RIRS via disposable electronic soft mirror, while the control group accepted RIRS via conventional repeatable soft mirror. The two groups were compared in the aspect of surgical data. Patients' serum renal function indicators [blood urea nitrogen (BUN), creatinine (Cr), cystatin C (CysC)], PGE2 and 5-HT levels were tested preoperative and postoperative 24 h. Postoperative complications and recurrence were compared between the two groups after 6 months follow-up. The patients were grouped according to whether there was recurrence or not. The medical records of recurrence group and non-recurrence group were collected, and the risk factors of recurrence were analyzed statistically.Results There was no sxtatistically significant difference between the observation group and the control group in terms of surgical time, intraoperative bleeding, one-time stone removal rate, and hospital stay (P > 0.05). After operation both groups saw much higher levels of BUN, Cr, CysC, PGE2 and 5-HT than they did before the operation (P < 0.05), but no significant difference in the aforementioned indicators was seen between the two groups either before or after the operation (P > 0.05). The incidence of complications and recurrence rate of the observation group were 3.51% and 15.79% respectively, seeing no big difference from 12.28% and 21.05% of the control group (P > 0.05). The body mass index (BMI), postoperative residual calculi and urinary tract infections in the recurrence team were remarkably higher than those in the non recurrence team (P < 0.05). The results of multivariate Logistic regression analysis showed that after adjusting for confounding factors such as gender, age, course of disease, maximum diameter of calculi, number of calculi, location of calculi, and surgical method, postoperative residual calculi and postoperative urinary tract infections were independent risk factors for postoperative recurrence of upper ureteral calculi after RIRS (P < 0.05).Conclusion Both disposable electronic soft endoscopy and conventional repeatable soft endoscopy can achieve satisfactory results in the treatment of upper ureteral calculi, both can impact the renal function and serum PGE2, 5-HT levels in patients to a certain extent, and both present a risk of recurrence after surgery. Residual postoperative calculi and postoperative urinary tract infections are independent risk factors inducing recurrence of upper ureteral calculi after RIRS.