摘要
目的探究输尿管硬镜激光碎石术(urete roscopic lithotripsy,URL)、输尿管软镜碎石术(flexible ureteroscopic lithotripsy,FURL)与经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)对输尿管结石患者围手术期疼痛及应激反应、肾功能的影响。方法选取2019年5月至2022年5月宜春市第二人民医院泌尿外科收治的70例输尿管结石患者作为研究对象,按照不同手术方式分为A组(n=23)、B组(n=23)及C组(n=24)。A组行URL治疗,B组行FURL治疗,C组行PCNL治疗。比较3组手术相关指标、结石清除率、应激反应[去甲肾上腺素(norepinephrine,NE)、皮质醇(cortisol,Cor)]及疼痛症状[视觉模拟评分法(visual analogue scale,VAS)]、肾功能指标[尿素氮(blood urea nitrogen,BUN)、血肌酐(serum creatinine,SCr)、肾小球滤过率(glomerular filtration rate,GFR)]。结果3组手术时间、术中出血量、术后血尿持续时间比较差异有统计学意义(P<0.05);C组手术时间、术后血尿持续时间均长于A组、B组,术中出血量多于A组、B组,差异有统计学意义(P<0.05)。3组结石清除率比较差异有统计学意义(P<0.05);C组结石清除率高于A组,差异有统计学意义(P<0.05)。3组VAS评分及血清NE、Cor水平比较差异有统计学意义(P<0.05);C组VAS评分及血清NE、Cor水平均高于A组、B组,差异有统计学意义(P<0.05)。3组血清SCr、BUN水平及GFR比较差异有统计学意义(P<0.05);B组SCr、BUN水平均低于A组、C组,GFR高于A组、C组,差异有统计学意义(P<0.05)。结论URL、FURL与PCNL均可有效治疗输尿管结石,其中PCNL结石清除率更高,但术后疼痛明显,应激反应严重,而FURL肾功能保护作用更明显,URL手术时间更短、术中出血量更少。
Objective To explore the effects of urete roscopic lithotripsy(URL),flexible ureteroscopic lithotripsy(FURL)and percutaneous nephrolithotomy(PCNL)on perioperative pain,stress response and renal function in patients with ureteral calculi.Methods a total of 70 patients with ureteral calculi admitted to the Urology department of Second People's Hospital of Yichun from May 2019 to may 2022 were selected as the research subjects,they were divided into the group A(n=23),the group B(n=23)and the group C(n=24)according to different surgical methods.The group A received URL treatment,the group B received FURL treatment,and the group C received PCNL treatment.The operation related indicators,stone clearance rate,stress response(norepinephrine[NE],cortisol[Cor]),pain symptoms(visual analogue scale[VAS]),renal function indicators(blood urea nitrogen[BUN],serum creatinine[SCr],glomerular filtration rate[GFR])were compared among the three groups.Results There were significant differences in operative time,intraoperative bleeding and postoperative hematuria duration among the three groups(P<0.05);the operation time and postoperative hematuria duration in the group C were longer than those in the group A and the group B,and the intraoperative blood loss in the group C was more than that in the group A and group B,the differences were statistically significant(P<0.05).There was significant differences in stone clearance rate among the three groups(P<0.05);the stone clearance rate in the C was higher than that in the group A,the difference was statistically significant(P<0.05).There were significant differences in VAS score,serum NE and Cor levels among the three groups(P<0.05);the VAS score,serum NE and Cor levels in the group C were higher than those in the group A and group B,the differences were statistically significant(P<0.05).There were significant differences in serum SCr,BUN and GFR among the three groups(P<0.05);the levels of SCr and BUN in the group B were lower than those in the group A and group C,and the GFR was higher than that in the group A and the group C,the differences were statistically significant(P<0.05).Conclusion URL,FURL and PCNL are all effective in treating ureteral stones,PCNL has a higher stone clearance rate,but the postoperative pain is obvious and the stress reaction is serious,while FURL has a more obvious protective effect on renal function,the URL has shorter operation time and less intraoperative bleeding.
作者
杨于钢
卢佳
胡啸
YANG Yugang;LU Jia;HU Xiao(Department of Urology,Second People's Hospital of Yichun,Yichun,Jiangxi,336000,China)
出处
《当代医学》
2025年第2期59-63,共5页
Contemporary Medicine
