Study on the curative effect of traditional Chinese medicine combined with occluder in reducing ureteral stricture caused by holmium laser lithotripsy

doi:10.3760/cma.j.issn.1007-1245.2023.21.012

Abstract

Abstract:

Objective　To investigate the effect of traditional Chinese medicine prescription for clearing heat, promoting blood circulation, and softening combined with occluder in reducing ureteral stricture caused by holmium laser lithotripsy. Methods　Clinical data of 200 patients with middle and upper ureteral calculi from Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine from January 2015 to March 2023 were retrospectively analyzed, including 144 males and 56 females, aged (52±13.8) years. According to whether the occluder was used during operation and whether traditional Chinese medicine was used after operation, they were divided into group A (66 cases, holmium laser combined with occluder and traditional Chinese medicine), group B (70 cases, holmium laser alone), and group C (64 cases, holmium laser combined with occluder). Self-designed Chinese medicine prescription was as follow: spreading hedyotis herb, sophora, cordate houttuynia, glabrous greenbrier rhizome, epimedium, dogwood, grifola, alisma, motherwort, and radix cyathulae. The incidence of perirenal hematoma, ureteral stenosis, stone clearance rate, and improvement of hydronephrosis were observed 3 months after operation. F test, rank sum test, and χ² test were used. Results　There was no statistically significant difference in the incidence of perirenal hematoma among the three groups (χ²=2.474, P>0.05). There was a statistically significant difference in the incidence of postoperative ureteral stricture among the three groups (χ²=6.412, P<0.05); there was a statistically significant difference between group A and group B (χ²=5.402, P<0.05); there was no statistically significant difference between group A and group C (χ²=0.374, P>0.05); there was no statistically significant difference between group C and group B (χ²=3.331, P>0.05). There was a statistically significant difference in the stone clearance among the three groups (χ²=12.842, P<0.05); there was a statistically significant difference between group A and group B (χ²=9.597, P<0.05); there was no statistically significant difference between group A and group C (χ²=0.374, P>0.05); there was a statistically significant difference between group C and group B (χ²=7.022, P<0.05). There was no statistically significant difference in the improvement degree of hydronephrosis among the three groups (H=2.894, P>0.05). Conclusion　The treatment of middle and upper ureteral calculi with heat-clearing, blood-activating, and helping softening prescription combined with occluder can reduce the incidence of ureteral stricture or atresia caused by ureteral holmium laser lithotripsy, reflecting the effect of traditional Chinese medicine prescription on ureteral wall regeneration and repair, promoting blood circulation, clearing heat, reducing dampness, and promoting softening.

Key words:

Holmium laser lithotripsy, Ureteral stricture, Traditional Chinese medicine, Occluder

摘要：

目的　探讨清热活血助软化中药方剂联合封堵器减少输尿管钬激光碎石所致输尿管狭窄的疗效。方法　回顾性分析广东省中西医结合医院2015年1月至2023年3月200例输尿管中上段结石患者的临床资料，男性144例，女性56例，年龄（52±13.8）岁，根据术中是否使用封堵器及术后是否使用中药，分为A组（钬激光联合封堵器和中药）66例、B组（单纯钬激光）70例、C组（钬激光联合封堵器）64例。自拟中药方剂：白花蛇舌草、苦参、鱼腥草、土茯苓、淫羊藿、山茱萸、猪苓、泽泻、益母草、川牛膝。观察术后肾周血肿发生率，术后3个月输尿管狭窄发生率，结石清除率及肾积水改善情况。采用F检验、秩和检验、χ²检验。结果　3组肾周血肿发生率比较差异无统计学意义（χ²=2.474，P>0.05）。3组术后输尿管狭窄发生率比较差异有统计学意义（χ²=6.412，P<0.05）；A组与B组术后输尿管狭窄发生率比较差异有统计学意义（χ²=5.402，P<0.05）；A组与C组术后输尿管狭窄发生率比较差异无统计学意义（χ²=0.374，P>0.05）；C组与B组术后输尿管狭窄发生率比较差异无统计学意义（χ²=3.331，P>0.05）。3组结石清除率比较差异有统计学意义（χ²=12.842，P<0.05）；A组与B组结石清除率比较差异有统计学意义（χ²=9.597，P<0.05）；A与C组结石清除率比较差异无统计学意义（χ²=0.374，P>0.05）；C组与B组结石清除率比较差异有统计学意义（χ²=7.022，P<0.05）。3组肾积水改善程度比较差异无统计学意义（H=2.894，P>0.05）。结论　通过清热活血助软化方剂联合封堵器治疗输尿管中上段结石可降低输尿管钬激光碎石所致的输尿管狭窄或闭锁的发生率，体现中药方剂对输尿管壁再生修复及活血化瘀、清热利湿消肿促软化的作用。

关键词:

钬激光碎石, 输尿管狭窄, 中药, 封堵器

Liao Tuming, Zeng Weifang, Liu Liangjin, He Shen, Guan Gangqiang, Li Xiongcai, Zhu Herong, Wu Jiaqiao, Du Wei.

Study on the curative effect of traditional Chinese medicine combined with occluder in reducing ureteral stricture caused by holmium laser lithotripsy [J]. International Medicine and Health Guidance News, 2023, 29(21): 3040-3044.

廖土明曾炜芳刘良金何燊关刚强李雄才朱和荣吴佳桥杜伟.

中药联合封堵器减少钬激光碎石所致输尿管狭窄的疗效研究 [J]. 国际医药卫生导报, 2023, 29(21): 3040-3044.

References

[1] Haleblian G, Kijvikai K, de la Rosette J, et al. Ureteral stenting and urinary stone management: a systematic review[J]. J Urol, 2008, 179(2):424-430. DOI: 10.1016/j.juro.2007.09.026.
[2] 刘为池,刘刚,唐锦护,等.输尿管镜下钬激光碎石术后并发输尿管狭窄回顾性分析[J].临床泌尿外科杂志,2014,29(7):573-574,580. DOI:10.13201/j.issn.1001-1420.2014. 07.004.
[3] 叶照华,米其武,罗杰鑫,等.输尿管结石行输尿管镜下碎石术后并发输尿管狭窄的危险因素分析[J/CD].中华腔镜泌尿外科杂志(电子版),2017,11(1):40-42.DOI:10.3877/cma.j.issn.1674-3253.2017.01.011.
[4] 刘跃闻,李建中,周亚军,等.输尿管镜钬激光碎石术后继发输尿管狭窄的危险因素分析[J].临床泌尿外科杂志,2019,34(8):621-624.DOI:10.13201/j.issn.1001-1420.2019. 08.008.
[5] 农绍军,张跃平,蔡晓晴,等.联合应用钬激光及封堵器在输尿管镜治疗输尿管上段结石的应用[J].江苏医药,2014,40(17):2029-2031.DOI:10.19460/j.cnki.0253-3685.2014. 17.017.
[6] 杨平,陈雪莲.输尿管镜术联合中药汤剂治疗输尿管狭窄并结石[J].环球中医药,2014,7(S1):72.
[7] 黄涛,吕秀梅,梅雪峰.输尿管镜手术配合中药治疗输尿管狭窄68例观察[J].现代临床医学,2013,39(2):106-107,109.DOI:10.3969/j.issn.1673-1557.2013.02.012.
[8] 罗金花,丁宁.22～24℃冲洗液预防输尿管钬激光碎石术后输尿管狭窄的效果探讨[J].南通大学学报(医学版),2020,40(6):574-576.DOI:10.16424/j.cnki.cn32-1807/r.2020.06.025.
[9] 王进,李森,张友朋,等.改良输尿管镜钬激光碎石术治疗输尿管结石的技巧探讨(附76例报告)[J].临床泌尿外科杂志,2013,28(07):533-536.DOI:10.13201/j.issn.1001-1420. 2013.07.009.
[10] 万优,许长宝,赵兴华,等.输尿管上段嵌顿性结石术后发生输尿管狭窄的影响因素分析[J].微创泌尿外科杂志,2020,9(5):324-329.DOI:10.19558/j.cnki.10-1020/r.2020. 05.008.
[11] 覃斌,黄向华,李长赞,等.输尿管镜下钬激光碎石与气压弹道碎石术治疗输尿管结石的疗效比较[J/CD].中华腔镜泌尿外科杂志(电子版),2012,06(1):38-41.DOI:10.3877/cma.j.issn.1674-3253.2012.01.010.
[12] Tyritzis SI, Wiklund NP. Ureteral strictures revisited…trying to see the light at the end of the tunnel: a comprehensive review[J]. J Endourol, 2015, 29(2):124-36. DOI: 10.1089/end.2014.0522.
[13] 陈柯宇,王亮.钬激光碎石术后输尿管狭窄的相关因素分析[J].四川医学,2018,39(12):1345-1349.DOI:10.16252/j.cnki.issn1004-0501-2018.12.008.
[14] 乃比江·毛拉库尔班,柔孜麦麦提·艾合麦提江,夏韩,等.基于贝叶斯网络模型分析输尿管结石患者碎石术后输尿管狭窄的发生因素[J].现代泌尿外科杂志,2022,27(11):897-902.DOI:10.3969/j.issn.1009‐8291.2022.11.002.
[15] 王成路,金露,薛波新.术前预测输尿管嵌顿性结石的临床因素分析[J].中华泌尿外科杂志,2019,40(1):42-46.DOI:10.3760/cma.j.issn.1000-6702.2019.01.008.
[16] 陈亮,张仁涛,丁银满,等.输尿管软镜鞘扩张法治疗输尿管狭窄合并结石初步体会[J/CD].中华腔镜泌尿外科杂志(电子版),2021,15(3):226-228.DOI:10.3877/cma.j.issn.1674- 3253.2021.03.010.
[17] 辛晓雷,方林.输尿管镜腔内治疗输尿管狭窄(附65例报告)[J].临床泌尿外科杂志,2023,38(3):218-222.DOI:10.13201/j.issn.1001-1420.2023.03.014.
[18] 韩鹏,鲁佩,张炜,等.球囊扩张术后留置双J管策略对继发性输尿管狭窄的近期疗效分析[J].临床泌尿外科杂志,2023,38(1):33-38.DOI:10.13201/j.issn.1001-1420.2023. 01.008.
[19] 刘吉平,张国胜,单小辉,等.钬激光联合封堵导管、取石网篮"三步法"治疗输尿管中上段结石[J].中国微创外科杂志,2022,22(12):958-961.DOI:10.3969/j.issn.1009-6604. 2022.12.006.
[20] Fam XI, Singam P, Ho CC, et al. Ureteral stricture formation after ureteroscope treatment of impacted calculi: a prospective study[J]. Korean J Urol, 2015, 56(1):63-7. DOI: 10.4111/kju.2015.56.1.63.