输尿管软镜铥激光碎石术联合微通道经皮肾镜取石术治疗上尿路结石的临床疗效及安全性分析

Analysis of the efficacy and safety of ureteroscopic holmium laser lithotripsy combined with microchannel percutaneous nephrolithotomy in treating upper urinary tract calculus

摘要:

目的 分析输尿管软镜铥激光碎石术联合微通道经皮肾镜取石术（mPCNL）治疗上尿路结石的临床疗效和安全性。方法 选择2020年9月－2023年9月该院收治的上尿路结石患者300例，采用随机数表法将患者分为对照1组、对照2组和联合组，各100例。对照1组采用输尿管软镜铥激光碎石术治疗，对照2组采用mPCNL治疗，联合组采用输尿管软镜铥激光碎石术联合mPCNL治疗。比较3组患者围手术期指标、血清炎症因子水平、疼痛评分和并发症发生率。结果 联合组结石清除率明显高于对照1组和对照2组，手术时间明显长于对照1组和对照2组，住院时间明显短于对照1组和对照2组，但对照1组术中出血量明显少于联合组和对照2组，差异均有统计学意义（P < 0.05）。3组患者术后1 h肿瘤坏死因子α（TNF-α）水平明显高于术前，术后12和24 h TNF-α水平明显低于术后1 h，差异均有统计学意义（P < 0.05）。3组患者术后1和12 h降钙素原（PCT）水平明显高于术前，术后24 h PCT水平明显低于术后12 h，但明显高于术前和术后1 h，差异均有统计学意义（P < 0.05）。3组患者术后1、12和24 h 视觉模拟评分法（VAS）评分均依次降低，且对照1组明显低于联合组和对照2组，差异均有统计学意义（P < 0.05）。3组患者并发症总发生率比较，差异无统计学意义（P > 0.05）。结论 输尿管软镜铥激光碎石术联合mPCNL治疗上尿路结石，结石清除率高，术后恢复快，且未增加并发症发生率。

Abstract:

Objective To evaluate the efficacy and safety of combining ureteroscopic holmium laser lithotripsy with microchannel percutaneous nephrolithotomy (mPCNL) in the treatment of upper urinary tract calculus.Methods From September 2020 to September 2023, 300 patients diagnosed with upper urinary tract calculus were randomly divided into control group 1, control group 2, and the combined group by random number table method, 100 patients in each. Control group 1 received treatment via ureteroscopic holmium laser lithotripsy, control group 2 underwent mPCNL, while the combined group was treated with a combination of ureteroscopic holmium laser lithotripsy and mPCNL. The perioperative indicators, serum inflammatory factor levels, pain scores, and incidence of complications were compared among the three groups.Results The stone clearance rate of the combined group was higher than that of control group 1 and control group 2, the surgical time was longer than that of control group 1 and control group 2, and the hospitalization time was shorter than that of control group 1 and control group 2, but the intraoperative bleeding volume of control group 1 was less than that of combined group and control group 2, the differences were statistically significant (P < 0.05). Compared with before surgery, the levels of tumor necrosis factor-α (TNF-α) in three groups was increased 1 h after surgery; Compared with 1 h after surgery, the levels of TNF-α in three groups were decreased at 12 and 24 h after surgery, the differences were statistically significant (P < 0.05). The procalcitonin (PCT) levels of the three groups at 1 and 12 h after the operation were significantly higher than those before the operation. The PCT level at 24 h after the operation was significantly lower than that at 12 h after the operation, but significantly higher than that before the operation and 1 h after the operation in three groups, the differences were statistically significant (P < 0.05). At 1, 12, and 24 h after surgery, the visual analogue scale (VAS) scores of the three groups decreased sequentially, and the control group 1 was lower than that of combined group and control group 1, the difference was statistically significant (P < 0.05). The total incidence of complications was no statistically obviously different among the three groups (P > 0.05).Conclusion The ureteroscopic holmium laser lithotripsy combined with mPCNL for upper urinary tract calculus has a high stone clearance rate, fast postoperative recovery, and does not increase the incidence of complications.