输尿管软镜下钬激光碎石术治疗小于2 cm肾结石的效果观察

doi:10.19558/j.cnki.10-1020/r.2020.06.005

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摘要 目的： 分析电子输尿管软镜下钬激光碎石治疗<2 cm肾结石的疗效。方法： 将成都市第三人民医院泌尿外科2016年1月–2019年4月收治的217例肾结石患者分为观察组（99例）接受电子输尿管软镜下钬激光碎石术,对照组（108例）接受经皮肾镜下钬激光碎石术。比较两组患者手术相关情况、不同时间点的尿肾损伤分子-1（KIM-1）及胱抑素C（Cys-C）水平、机体应激反应指标水平;并统计围术期并发症发生率。结果： 观察组术后住院时间较对照组短,术后血红蛋白下降值、一期结石清除率显著低于对照组（P<0.05）;术后6~48 h两组尿KIM-1、Cys-C水平较术前均有不同程度上升,但观察组术后24、48 h的尿KIM-1水平显著低于对照组,术后12、24、48、72 h的血Cys-C水平显著高于对照组（P<0.05）;术后两组血管紧张素-Ⅱ（Ang-Ⅱ）、皮质醇（Cor）、去甲肾上腺素（NE）、肾上腺素（AD）较术前均显著上升,但观察组Ang-Ⅱ、NE、AD、Cor均显著低于对照组（P<0.05）;两组围术期并发症发生率（6.06% vs. 10.19%）差异无统计学意义（P>0.05）。结论： 相对于经皮肾镜下钬激光碎石术,电子输尿管软镜下钬激光碎石对肾功能的影响更小,具更低的机体应激反应,但一期结石清除率较低,值得临床重视。

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	颜春连
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关键词 ：电子输尿管软镜, 钬激光碎石, 肾结石, 尿肾损伤分子-1, 胱抑素C, 机体应激反应

Abstract：Objective： To analyze the efficacy of holmium laser lithotripsy through flexible ureteroscope in treatment of kidney stones smaller than 2 cm. Methods： A total of 217 patients with kidney stones who were treated in Urology Department of our hospital between January 2016 and April 2019 were divided into the observation group （treated with holmium laser lithotripsy through flexible ureteroscope, n = 99） and the control group （treated with percutaneous nephroscopic holmium laser lithotripsy, n = 108） according to the surgical procedures. Operation related conditions, levels of urine kidney injury molecule-1 （KIM-1）, Cystatin C （Cys-C） and stress response indicators at different time points were compared between the two groups. The incidence of perioperative complications was statistically analyzed. Results： Postoperative hospital stay was shorter, and the postoperative decreased value of hemoglobin and one-stage stone removal rate were significantly lower in the observation group than those in the control group （P < 0.05）. Urine KIM-1 and Cys-C levels in both groups increased 6-48 h after operation. However, urine KIM-1 levels in the observation group at 24 h and 48 h after operation were significantly lower than those in the control group. The blood Cys-C levels at 12 h, 24 h, 48 h and 72 h after operation were significantly higher than those in the control group （P < 0.05）. Angiotensin-II （Ang-Ⅱ）, cortisol （Cor）, norepinephrine （NE） and adrenaline （AD） were increased significantly after operation, but they were significantly lower in the observation group than in the control group （P < 0.05）. There were no statistically significant differences in incidence of perioperative complications between the two groups （6.06% vs. 10.19%, P > 0.05）. Conclusion： Compared with percutaneous nephroscopic holmium laser lithotripsy, holmium laser lithotripsy through flexible ureteroscope has less effect on renal function, with milder stress response. However, the one-stage stone clearance rate is lower.

Key words： flexible ureteroscope holmium laser lithotripsy kidney stones urine renal injury molecule-1 Cystatin C stress response

收稿日期: 2020-03-06

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通讯作者: 胡小剑,376643497@qq.com

引用本文:

颜春连, 万繁, 席翔, 符磊, 胡小剑. 输尿管软镜下钬激光碎石术治疗小于2 cm肾结石的效果观察[J]. 微创泌尿外科杂志, 2020, 9(6): 380-385.
YAN Chunlian, WAN Fan, XI Xiang, FU Lei, HU Xiaojian. Efficacy of holmium laser lithotripsy through flexible ureteroscope in treatment of kidney stones smaller than 2 cm. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(6): 380-385.

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[1] WANG Q, GUO J, HU H, et al.Rigid ureteroscopic lithotripsy versus percutaneous nephrolithotomy for large proximal ureteral stones: A meta-analysis. PLoS One, 2017,12(2):e0171478.
[2] ABOUTALEB H.Fluoroscopy free flexible ureteroscopy with Holmium: Yttrium-aluminium-garnet laser lithotripsy for removal of renal calculi. Arab J Urol, 2016,14(2):123-130.
[3] STERNBERG KM, JACOBS BL, KING BJ, et al.The prone ureteroscopic technique for managing large stone burdens. Can J Urol, 2015,22(2):7758-7762.
[4] DAGROSA L, MOSES R, PAIS VJ.Incidence and implications of silent hydronephrosis following percutaneous nephrolithotomy. Clin Nephrol, 2017,87(2017)(1):29-32.
[5] 徐勇杰,毛金尉,张瑞龙,等.组合式输尿管软镜联合钬激光碎石术治疗上尿路结石143例.中国微创外科杂志,2016,16(11):977-979,989.
[6] 胡豪,陈欣,蒋立,等.一期输尿管软镜钬激光碎石术治疗≤2cm单侧上尿路结石的临床研究.第三军医大学学报,2018,40(12):1148-1154.
[7] 曾国华,李佳胜,赵志健,等.逆行软性输尿管镜下钬激光碎石术治疗肾结石的有效性与安全性分析.中华泌尿外科杂志,2015,36(6):401-404.
[8] 常启跃,叶茂,罗琦,等.输尿管软镜治疗>2 cm肾和输尿管上段结石的疗效和安全性评价.第三军医大学学报,2016,38(3):302-306.
[9] 钟瑞伦,杨国胜,邱晓拂,等.输尿管软镜碎石术和经皮肾镜碎石术治疗小于2cm肾结石对机体应激反应的探讨.中国内镜杂志,2015,21(9):906-909.
[10] 何江,康郑军.输尿管软镜和超微经皮肾镜对直径1~2cm肾下盏结石疗效及安全性的影响.广东医学,2019,40(12):1784-1787.
[11] 李建伟,王芳,蔡芳震,等.分期输尿管软镜与微创经皮肾镜治疗2~4cm肾盂结石的随机对照研究.中国微创外科杂志,2016,16(10):884-888.
[12] 何昊,尹志康,吴小侯,等.四种微创方式治疗1275例输尿管上段结石的临床研究.重庆医科大学学报,2015,40(5):758-764.
[13] 蒋祥新,蔡万松,闻立平.输尿管软镜鞘直视置入法钬激光碎石术一期治疗肾结石的临床分析.中华泌尿外科杂志,2016,37(12):932-935.
[14] HAMAMOTO S, UNNO R, TAGUCHI K, et al.Determinants of health-related quality of Life for patients after urinary lithotripsy: ureteroscopic vs. shock wave lithotripsy. Urolithiasis, 2018,46(2):203-210.
[15] YUAN XL, LI CS, ZHANG Y, et al.Extracorporeal membrane oxygenation improving survival and alleviating kidney injury in a swine model of cardiac arrest compared to conventional cardiopulmonary resuscitation. Chin Med J (Engl), 2018,131(15):1840-1848.
[16] LEE SH, YOUN YN, CHOO HC, et al.Cystatin C as a predictive marker of renal dysfunction and mid-term outcomes following off-pump coronary artery bypass grafting. Heart, 2015,101(19):1562-1568.
[17] 安宇,黄建林,张峰,等.输尿管软镜与经皮肾镜钬激光碎石术对肾结石患者肾功能的影响.现代生物医学进展,2015,15(35):6863-6866.
[18] 李毅,陈刚,文爽,等.输尿管软镜钬激光碎石术治疗长径≥2cm的肾结石68例临床分析.第三军医大学学报,2016,38(13):1547-1551.
[19] 韩宇平,尚东梅.组合式输尿管软镜与经皮肾镜碎石术治疗老年肾结石的疗效比较.中国老年学杂志,2016,36(8):1935-1937.