摘要
目的探讨同轴顺行输尿管软镜辅助经皮肾镜取石术在上尿路结石治疗中的临床疗效及安全性,为结石微创治疗提供新方案。方法选取2021年1月至2024年12月湖州师范学院附属第一医院泌尿外科收治的162例上尿路结石患者,根据随机、对照、单盲的原则分为三组,单纯经皮肾镜组(A组,n=54),单纯顺行联合组(B组,n=57),同轴顺行联合组(C组,n=51),比较三组围手术指标、炎症指标、疼痛评分和手术并发症发生率。结果C组术后1个月结石清除率达96%(49/51,残石直径<3 mm),显著高于A组的92%(50/54)及B组的87%(47/57),组间比较差异有统计学意义(χ^(2)=5.87,P=0.015);C组手术时长(92.96±26.26)min、住院天数(6.58±1.14)d及术中结石定位时间(10.0±3.6)s,均较A、B两组缩短,差异有统计学意义(F值分别为12.83、42.61、18.52,P<0.05);C组C反应蛋白水平为(10.51±0.03)mg/L,低于A组及B组,差异有统计学意义(P<0.05)。三组患者在术中出血量、白细胞/中性粒细胞水平、疼痛评分及并发症总发生率比较,差异无统计学意义(P>0.05)。结论同轴顺行输尿管软镜辅助经皮肾镜可通过“软硬镜协同引导”提升上尿路结石清除率,缩短手术时间及定位时间,且不增加安全风险,尤其适用于上尿路结石的微创治疗。
Objective To explore the clinical efficacy and safety of coaxial anterograde flexible ureteroscopyassisted percutaneous nephrolithotomy in the treatment of upper urinary tract calculi,and to provide a new minimally invasive treatment option for calculi.Methods A total of 162 patients with upper urinary tract calculi admitted to the Department of Urology of the First Affiliated Hospital of Huzhou Normal University from January 2021 to December 2024 were selected and divided into three groups according to the principles of randomization,control and single-blind.The simple percutaneous nephroscopy group(group A,n=54),the simple anterograde combined group(group B,n=57),and the coaxial anterograde combined group(group C,n=51)The perioperative indicators,inflammatory indicators,pain scores and the incidence of surgical complications were compared among the three groups.Result One month after the operation,the stone clearance rate in group C reached 96%(49/51,with residual stone diameter<3 mm),which was significantly higher than 92%(50/54)in group A and 87%(47/57)in group B.The difference between the groups was statistically significant(χ^(2)=5.87,P=0.015).The operation duration was(92.96±26.26)min,the hospital stay was(6.58±1.14)d,and the intraoperative stone localization time was(10.O±3.6)s,all of which were shorter than those of groups A and B.The differences were statistically significant by analysis of variance(F values were 12.83,42.61,and 18.52,respectively,all P<0.05).The C-reactive protein level in group C(10.51±0.03)was lower than that in group A and group B,and the difference was statistically significant(P<0.05).There was no statistically significant difference in intraoperative blood loss,white blood cell/neutrophil level,pain score and total incidence of complications among the three groups of patients(P>O.05).Conclusion Coaxial progressive flexible ureteroscopy assisted percutaneous nephroscopy can increase the clearance rate of upper urinary tract calculi,shorten the operation time and positioning time through"flexible and rigid endoscope coordinated guidance",and does not increase safety risks.It is particularly suitable for minimally invasive treatment of upper urinary tract calculi.
作者
章佳宇
陈煜
汪宁
高建国
常豪哲
Zhang Jiayu;Chen Yu;Wang Ning;Gao Jianguo;Chang Haozhe(Department of Urology,The First Affiliated Hospital of Huzhou University,Huzhou,Zhejiang 31300,China;Huzhou Key Laboratory of Precise Diagnosis and Treatment of Urinary Tumors,Huzhou,Zhejiang 31300,China)
出处
《泌尿外科杂志(电子版)》
2025年第4期25-30,共6页
Journal of Urology for Clinicians(Electronic Version)
基金
湖州市科技局公益性应用研究(2021GY06)。
关键词
上尿路结石
经皮肾镜取石术
输尿管镜
结石清除率
Upper urinary tract calculi
Percutaneous nephrolithotomy
Ureteroscope
Stone clearance rate
