输尿管软镜联合末端可弯曲输尿管软镜鞘治疗肾结石的临床研究

Clinical effect of flexible ureteroscopy combined with flexible terminal suction ureteral access sheath in treatment of kidney stones

摘要:

目的 探讨输尿管软镜联合末端可弯曲输尿管软镜鞘（FTS-UAS）治疗肾结石的临床效果。方法 回顾性分析2022年6月—2023年8月陕西中医药大学第二附属医院泌尿外科收治的94例肾结石患者的临床资料。按照不同的手术方案分为对照组（50例，输尿管软镜联合常规鞘）和观察组（44例，输尿管软镜联合FTS-UAS）。观察两组术后1 d、3 d、4周的结石清除率，统计手术指标、视觉模拟评分法（VAS）、并发症及恢复情况。结果 观察组术后1 d、3 d、4周结石清除率高于对照组（P <0.05）。两组手术时间、术中出血量、血红蛋白下降幅度比较，差异均无统计学意义（P >0.05）。观察组术前、术后1 d VAS评分的差值高于对照组。两组并发症总发生率比较，差异无统计学意义（P >0.05），两组并发症的Clavien分级均为Ⅰ级。观察组术后血尿持续时间短于对照组（P <0.05）。两组住院时间、住院费用比较，差异均无统计学意义（P >0.05）。结论 输尿管软镜联合FTS-UAS治疗肾结石具有较高的结石清除率，还可减轻疼痛程度，且不会增加并发症的发生。

Abstract:

Objective To investigate the clinical effect of flexible ureteroscopy combined with flexible terminal suction ureteral access sheath (FTS-UAS) in the treatment of kidney stones.Methods The clinical data of 94 patients with kidney stones admitted to the Department of Urology in the Second Affiliated Hospital of Shaanxi Traditional Chinese Medicine from June 2022 to August 2023 were retrospectively analyzed. They were divided into the control group (n = 50, flexible ureteroscopy combined with conventional sheath) and the observation group (n = 44, flexible ureteroscopy combined with FTS-UAS) according to different surgical procedures. The stone clearance rates 1 day, 3 days and 4 weeks after the operation were observed in the two groups, and surgery-related indicators, VAS scores, complications and recovery were statistically analyzed.Results The stone clearance rates 1 day, 3 days and 4 weeks after the operation in the observation group were higher than those in the control group (P < 0.05), and the stone clearance rate 4 weeks after the operation was higher than that 1 day after the operation (P < 0.05). There was no difference in the operative duration, intraoperative blood loss or hemoglobin reduction between the two groups (P > 0.05). The difference of VAS scores before and 1 day after surgery in the observation group was higher than that in the control group. The overall incidence of complications was not different between the observation group and the control group (P > 0.05). The complications in the two groups were all of grade I as assessed via the Clavien-Dindo classification. The duration of postoperative hematuria was shorter in the observation group compared with that in the control group (P < 0.05). The differences in the length of hospital stays and hospitalization costs between the two groups were not statistically significant (P > 0.05).Conclusions Flexible ureteroscopy combined with FTS-UAS has a higher stone clearance rate in the treatment of kidney stones, and reduces the degree of pain without increasing the incidence of complications.