输尿管软镜联合可弯曲负压吸引鞘用于感染性肾结石取石术的倾向评分匹配分析

Analysis of propensity score matching of flexible ureteroscopy combined with flexible negative pressure suction sheath in the treatment of infectious renal calculus lithotomy

摘要:

目的 基于倾向评分匹配（PSM）分析输尿管软镜联合可弯曲负压吸引鞘应用于感染性肾结石取石术的作用。方法 回顾性分析2022年4月－2024年4月该院收治的87例感染性肾结石患者的临床资料，均行输尿管软镜碎石取石术（FURL）治疗，根据术中选用输尿管软镜鞘（UAS）的不同，分为负压鞘组（n = 43）和常规鞘组（n = 44）。负压鞘组选用可弯曲负压吸引鞘行FURL，常规鞘组选用常规鞘行FURL。比较两组患者一般资料，并采用PSM平衡各指标。比较两组患者临床疗效、围手术期指标、术后降钙素原（PCT）、白细胞计数（WBC）水平和术后并发症发生情况。结果 通过PSM作1∶1匹配后，得到42对感染性肾结石患者。负压鞘组结石清除率为90.48%（38/42），明显高于常规鞘组的71.43%（30/42）（P < 0.05）；负压鞘组术中最小肾盂内压、平均肾盂内压和最大肾盂内压明显低于常规鞘组，手术时间和住院时间明显短于常规鞘组（P < 0.05）；负压鞘组术后2 h的PCT和WBC水平明显低于常规鞘组，PCT和WBC恢复至正常水平所需时间明显短于常规鞘组（P < 0.05）；负压鞘组术后并发症总发生率为9.52%（4/42），明显低于常规鞘组的28.57%（12/42）（P < 0.05）。结论 输尿管软镜联合可弯曲负压吸引鞘用于感染性肾结石取石术，临床疗效确切，有助于降低术中肾盂内压，缩短手术时间，降低术后PCT和WBC水平，加快术后恢复，且安全性较好。值得临床推广应用。

Abstract:

Objective Based on the propensity score matching (PSM), the effect of flexible ureteroscopy combined with flexible negative pressure suction sheath in the treatment of infectious renal calculus lithotomy was analyzed.Methods From April 2022 to April 2024, 87 patients with infectious renal calculus in our hospital were selected retrospectively. All patients were treated with flexible ureteroscopic lithotripsy (FURL). According to the different choice of ureteral access sheath (UAS) during operation, they were divided into negative pressure sheath group (n = 43) and conventional sheath group (n = 44). In the negative pressure sheath group, the flexible negative pressure suction sheath was used for FURL, and in the conventional sheath group, the conventional sheath was used for FURL. The general data of patients with infectious renal calculus between groups were compared, and the indicators were balanced by PSM. The clinical efficacy, perioperative indicators, levels of procalcitonin (PCT) and white blood cell count (WBC) and postoperative complications of patients with infectious renal calculus were compared between the two groups.Results After 1∶1 ratio matching by PSM, 42 pairs of patients with infectious renal calculus were obtained,. The stone clearance rate of negative pressure sheath group [90.48% (38/42)] was significantly higher than that of conventional sheath group [71.43% (30/42)] (P < 0.05). The minimum intrapelvic pressure, average intrapelvic pressure and maximum intrapelvic pressure in the negative pressure sheath group were lower than those in the conventional sheath group, operation time and hospitalization time in the negative pressure sheath group were shorter than those in the conventional sheath group (P < 0.05). The levels of PCT and WBC in the negative pressure sheath group were lower than those in the conventional sheath group at 2 h after operation, and the time for PCT and WBC to recover to the normal level were shorter than those in the conventional sheath group (P < 0.05). The total incidence of postoperative complications in negative pressure sheath group [9.52% (4/42)] was significantly lower than that in conventional sheath group [28.57% (12/42)] (P < 0.05).Conclusion Flexible ureteroscopy combined with flexible negative pressure suction sheath is effective in the treatment of renal calculus, which is helpful to reduce intra-operative renal pelvis pressure, shorten operation time, reduce PCT and WBC levels after operation, and promote patients' early recovery with good safety.