输尿管软镜钬激光碎石与硬镜气压弹道碎石治疗输尿管结石伴肾积水的疗效比较*

Comparison of the efficacy of holmium laser lithotripsy with flexible ureteroscope and pneumatic lithotripsy under rigid ureteroscope in the treatment of ureteral calculi with hydronephrosis*

摘要:

目的?比较输尿管软镜钬激光碎石与硬镜气压弹道碎石治疗输尿管结石伴肾积水患者的疗效。方法?选取2017年12月—2019年12月义乌市中心医院收治的输尿管结石伴肾积水患者106例，依据随机数字表法分为观察组、对照组，每组53例。观察组行输尿管软镜钬激光碎石术治疗，对照组行输尿管镜下气压弹道碎石术治疗。比较两组一次性结石清除率、手术情况、术后并发症，术前和术后3?d血清促肾上腺皮质激素（ACTH）、C反应蛋白（CRP）、皮质醇（COR）水平。结果?两组一次性结石清除率比较，差异无统计学意义（P?>0.05）。观察组住院时间和手术时间短于对照组（P?<0.05）。观察组术后并发症发生率低于对照组（P?<0.05）。对照组手术前后血清ACTH、CRP、COR的差值高于观察组（P?<0.05）。结论?输尿管软镜钬激光碎石术治疗输尿管结石伴肾积水患者术后并发症少，且可有效减轻应激反应，值得临床借鉴。

Abstract:

Objective?To compare the efficacy of holmium laser lithotripsy with flexible ureteroscope and pneumatic lithotripsy under rigid ureteroscope in the treatment of ureteral calculi with hydronephrosis.?Methods?The 106 patients with ureteral calculi and hydronephrosis admitted to our hospital from December 2017 to December 2019 were randomly divided into the observation group and the control group according to the random number table method, each with 53 cases. The patients in the observation group were treated with holmium laser lithotripsy with flexible ureteroscope, while the patients in the control group were treated with pneumatic lithotripsy under rigid ureteroscope. The one-time clearance rate of ureteral calculi, operation situation, postoperative complications, and the changes of serum adrenocorticotropic hormone (ACTH), C-reactive protein (CRP) and cortisol (COR) levels 3d prior to and after the operation were compared between the two groups.?Results?There was no significant difference in the clearance rate of ureteral calculi between the observation group and the control group (P > 0.05). The duration of hospitalization and operation in the observation group was shorter than that in the control group (P < 0.05). The postoperative complications in the observation group were fewer than those in the control group (P < 0.05). In addition, the differences of serum ACTH, CRP and COR before and after operation in the control group were higher than those in the observation group (P < 0.05).?Conclusions?The holmium laser lithotripsy with flexible ureteroscope for the treatment of ureteral calculi with hydronephrosis contributes to fewer postoperative complications and can effectively reduce the occurrence of stress reaction, which is of value for further clinical application.