摘要
目的探讨输尿管镜下钬激光碎石术治疗输尿管上段嵌顿性结石的效果及对肾功能、术后疼痛的影响。方法选取我院2017年11月-2019年2月收治的93例输尿管上段嵌顿性结石患者,根据治疗方式的不同分为研究组45例和对照组48例,研究组采用输尿管镜钬激光碎石术,对照组采用腹腔镜下输尿管切开取石术。比较两组排石效果,手术相关指标,术前和术后1 d肾功能指标[中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、血肌酐(SCr)、血尿素(BUN)]水平,术后12、24、48 h疼痛视觉模拟量表(visual analogue scale, VAS)评分,以及术后并发症发生情况。结果研究组手术时间、住院时间均短于对照组,术中出血量少于对照组,差异均有统计学意义(P<0.05)。两组一次性排石率及术后6个月结石复发率比较差异均无统计学意义(P>0.05)。研究组术前与术后1 d NGAL、SCr、BUN比较差异均无统计学意义(P>0.05),对照组仅术后1 d NGAL较术前升高(P<0.05);两组术后1 d组间比较,仅研究组NGAL低于对照组(P<0.01)。两组术后疼痛情况随着时间的延长而逐渐减轻,VAS评分术后48 h<术后24 h<术后12 h,差异均有统计学意义(P<0.05);且研究组术后相同时间VAS评分均低于对照组,差异均有统计学意义(P<0.05)。研究组术后并发症总发生率为4.44%明显低于对照组术后并发症总发生率16.67%(P<0.05)。结论虽输尿管镜下钬激光碎石术与腹腔镜下输尿管切开取石术治疗输尿管上段嵌顿性结石的排石效果相当,但前者对机体创伤小、手术时间短、术中出血量少,有利于减轻患者术后疼痛、保护肾功能,且术后并发症少。
Objective To investigate the effect of ureteroscopic holmium laser lithotripsy(UHLL) on incarcerated upper ureteral calculi and its influence on renal function and postoperative pain. Methods From November 2017 to February 2019, 93 patients with incarcerated upper ureteral calculi were divided into research group(n=45) and control group(n=48). The research group was treated with UHLL, and the control group was treated with laparoscopic ureterolithotomy. The results of stone removal and surgery-related indicators were compared between the two groups. The operation indexes, the renal function indexes [neutrophil gelatinase-associated lipocalin(NGAL), serum creatinine(SCR), blood urea nitrogen(BUN)] levels before and at 1 d after operation, the visual analogue scale(VAS) pain score at 12, 24 and 48 h after operation, and the postoperative complications were also compared. Results The duration of operation and length of hospitalization of the research group were significantly shorter than those of the control group, and the amount of intraoperative bleeding was significantly less than that of the control group(P<0.05). There was no significant difference in one-time success rate of stone removal and the rate of stone recurrence at 6 months after operation in the two groups(P> 0.05). There was no significant difference in the levels of NGAL, SCr and BUN in research group before operation and at 1 d after operation(P>0.05). The level of NGAL in the control group was only higher than that before operation(P<0.05). For the comparison between the two groups at 1 d after operation, the NGAL level in the research group was lower than that in the control group(P<0.01). Postoperative pain in the two groups was gradually decreased with time. The VAS score was the lowest at 48 h after operation, followed by that at 24 h and 12 h after operation(P<0.05). The VAS scores in research group were significantly lower than those in the control group at the same time point after operation(P<0.05). The total incidence of postoperative complications in the research group was 4.44%, which was significantly lower than that in the control group(16.67%)(P<0.05). Conclusion Although the effect of UHLL is comparable to that of laparoscopic ureterotomy in the treatment of incarcerated upper ureteral calculi, UHLL has the advantages of less trauma to the body, shorter duration of operation, and less intraoperative bleeding, which is conductive to reduction of postoperative pain and protection of renal function, as well as fewer postoperative complications.
作者
王裕中
张志超
李宏军
刘世民
王雨
WANG Yu-zhong;ZHANG Zhi-chao;LI Hong-jun;LIU Shi-ming;WANG Yu(Department of Urology,the Military Hospital of Qinhuangdao,Qinhuangdao,Hebei 066000,China)
出处
《临床误诊误治》
2020年第4期77-81,共5页
Clinical Misdiagnosis & Mistherapy
基金
秦皇岛市2017年市级科技计划项目(201703A125)。
