输尿管软镜下一期处理双肾结石的临床疗效

Clinical efficacy of one-stage treatment of bilateral kidney stones under flexible ureteroscopy

摘要:

目的 探究输尿管软镜一期手术治疗双肾结石的效果和安全性。方法 回顾性分析2018年1月－2023年10月于该院接受输尿管软镜碎石取石术治疗的112例双侧肾结石患者的临床资料。根据不同手术方式分为观察组和对照组，观察组（60例）采取输尿管软镜一期手术碎石，对照组（52例）采取分期手术碎石。比较两组患者手术时间、术中出血量、术后1个月结石清除率、术后血尿时间、腰腹痛持续时间、术后1 d肌酐水平和术后并发症发生率。结果 观察组手术时间为（103.68±27.46）min，较对照组的（132.51±39.74）min短，差异有统计学意义（P < 0.01）；观察组术后1个月结石清除率为91.67%，与对照组的90.38%比较，差异无统计学意义（P = 0.920）；观察组术中出血量为（15.29±5.15）mL，明显多于对照组的（12.00±3.62）mL，术后腰腹部疼痛持续时间为（6.18±1.40）d，明显长于对照组的（4.56±1.12）d，差异均有统计学意义（P < 0.01）；观察组术后血尿持续时间为（3.07±0.92）d，术后膀胱刺激征发生率为65.00%，术后中低热发生率为25.00%，术后1 d肌酐水平为（73.47±17.80）μmol/L，与对照组的术后血尿持续时间（2.73±1.28）d、术后膀胱刺激征发生率53.85%，术后中低热发生率17.31%、术后1 d肌酐水平（68.61±17.38）μmol/L相比较，差异均无统计学意义（P > 0.05）。结论 输尿管软镜下一期处理双肾结石手术是安全、有效的，且手术疗效与分期手术接近，但术后需加强护理和疼痛管理，以提高综合治疗效果。

Abstract:

Objective To explore the efficacy and safety of one-stage flexible ureteroscopic lithotripsy for bilateral kidney stones.Methods Retrospectively analyzed 112 patients with bilateral kidney stones treated by flexible ureteroscopic lithotripsy from January 2018 to October 2023. Based on the treatment procedure, the participants were divided into an observation group and a control group. The observation group (60 cases) underwent one-stage lithotripsy using flexible ureteroscopy for bilateral kidney stones, the control group (52 cases) received staged lithotripsy for bilateral kidney stones. The operation time, intraoperative blood loss, stone clearance rate one month after operation, postoperative hematuria time, duration of lumbar and abdominal pain, creatinine level one day after operation and incidence of postoperative complications were compared between the two groups of patients.Results Findings indicated that the observation group had a mean operation time of (103.68 ± 27.46) min, which was significantly shorter compared to the control group's mean operation time of (132.51 ± 39.74) min, the difference was statistically significant (P < 0.01). Additionally, the stone clearance rate after one month post-operation was 91.67% in the observation group and 90.38% in the control group (P = 0.920); The average blood loss of the observation group was (15.29 ± 5.15) mL, and the duration of postoperative lumbar and abdominal pain was (6.18 ± 1.40) d, while the average blood loss of the control group was (12.00 ± 3.62) mL, and the duration of postoperative lumbar and abdominal pain was (4.56 ± 1.12) d, with significant difference (P < 0.01); The duration of postoperative hematuria in the observation group was (3.07 ± 0.92) d, the incidence of postoperative irritation sign of bladder was 65.00%, the incidence of postoperative moderate and low fever was 25.00%, and the creatinine level on the first day after surgery was (73.47 ± 17.80) μmol/L, while the duration of postoperative hematuria in the control group was (2.73 ± 1.28) d, the incidence of postoperative irritation sign of bladder was 53.85%, the incidence of postoperative moderate and low fever was 17.31%, and the creatinine level on the first day after surgery was (68.61 ± 17.38) μmol/L, the differences were not statistically significant (P > 0.05).Conclusion One stage flexible ureteroscopic lithotripsy for bilateral kidney stones is safe and effective, moreover, the surgical outcome is close to that of staged surgery, but postoperative nursing and pain management should be strengthened in order to improve the effect of comprehensive treatment.