Efficacy of holmium laser lithotripsy under rigid ureteroscopy in the treatment of complex upper urinary calculi

doi:10.3760/cma.j.issn.1007-1245.2024.22.025

Abstract

Abstract:

Objective　To investigate the effect of rigid ureteroscopy combined with holmium laser lithotripsy in the intervention of complex upper urinary calculi and its effects on inflammation, complications, and recurrence. Methods　This study was a randomized controlled trial. A total of 138 patients with complex upper urinary calculi admitted to Dongguan Wanjiang Hospital from February 2022 to October 2023 were selected as the study objects and were divided into a control group (68 cases) and an observation group (70 cases) according to the random number table method. In the control group, 40 males and 28 females were (38.22±4.11) years old, and the stone diameter was (3.79±0.45) cm. In the observation group, 42 males and 28 females were (38.15±4.05) years old, and the stone diameter was (3.75±0.46) cm. The control group underwent traditional percutaneous nephrolithotomy, and the observation group underwent holmium laser lithotripsy under rigid ureteroscopy. Perioperative indicators, stone clearance rate, inflammatory response factors [C-reactive protein (CRP), interleukin-6 (IL-6), and procalcitonin (PCT)] before and after operation were compared between the two groups, and postoperative complications and recurrence were recorded after 6 months of follow-up. χ² test and t test were used. Results　In the observation group, the operation time was (95.15±8.56) min, the postoperative getting out of bed time was (1.45±0.42) d, the postoperative hospitalization time was (8.12±1.25) min, the intraoperative blood loss was (18.52±2.46) ml, and those in the control group were (116.52±10.15) min, (2.66±0.58) d, (13.45±1.76) d, and (41.18±4.05) ml, with statistically significant difference (t=17.617, 17.456, 25.340, and 46.816, all P<0.001). There was no statistically significant difference in the stone clearance rate between the observation group [97.14% (68/70)] and the control group [95.59% (65/68)] (χ²=0.238, P=0.625). Three days after surgery, the levels of CRP, IL-6, and PCT in both groups were lower than those before surgery, and those in the observation group were lower than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of postoperative complications between the two groups (χ²=0.238, P=0.625). After 6 months of follow-up, the recurrence rate of the observation group was lower than that of the control group [1.43% (1/70) vs. 10.29% (7/68)], with a statistically significant difference (χ²=4.964, P=0.026). Conclusions　Holmium laser lithotripsy under rigid ureteroscopy has a good effect on stone removal in patients with complex upper urinary calculi, and the postoperative complications are not significantly different from those of conventional percutaneous nephrolithotomy. However, holmium laser lithotripsy under rigid ureteroscopy has the advantages of short operation time, less surgical trauma, and fast postoperative recovery, which can reduce the inflammatory reaction and recurrence rate of stones, and is worth promoting.

Key words:

Holmium laser lithotripsy, Rigid ureteroscopy, Complex upper urinary calculi, Inflammatory factors, Complications, Recurrence

摘要：

目的　探讨经输尿管硬镜配合钬激光碎石术治疗复杂性上尿路结石的效果及对炎症、并发症及复发的影响。方法　本研究为随机对照试验。选取2022年2月至2023年10月东莞市万江医院收治的138例复杂性上尿路结石患者为研究对象，按随机数字表法分成对照组（68例）和观察组（70例）。对照组中男40例、女28例，年龄（38.22±4.11）岁，结石直径（3.79±0.45）cm，行传统经皮肾镜取石术。观察组男42例、女28例，年龄（38.15±4.05）岁，结石直径（3.75±0.46）cm，行输尿管硬镜下钬激光碎石术。比较两组围手术期指标、结石清除率，对比手术前后炎性反应因子［C反应蛋白（CRP）、白细胞介素-6（IL-6）、降钙素原（PCT）］，记录术后的并发症以及随访6个月复发的情况。采用χ²检验、t检验。结果　观察组患者手术时间为（95.15±8.56）min、术后下床时间为（1.45±0.42）d、术后住院时间为（8.12±1.25）min、术中出血量为（18.52±2.46）ml，对照组分别为（116.52±10.15）min、（2.66±0.58）d、（13.45±1.76）d、（41.18±4.05）ml，差异均有统计学意义（t=17.617、17.456、25.340、46.816，均P<0.001）。观察组结石清除率［97.14%（68/70）］与对照组［95.59%（65/68）］比较，差异无统计学意义（χ²=0.238，P=0.625）。术后3 d，两组CRP、IL-6、PCT水平均较术前降低，且观察组均低于对照组（均P<0.05）。两组术后并发症发生率差异无统计学意义（χ²=0.238，P=0.625）。术后随访6个月，观察组复发率低于对照组［1.43%（1/70）比10.29%（7/68）］，差异有统计学意义（χ²=4.964，P=0.026）。结论　输尿管硬镜下钬激光碎石术治疗复杂性上尿路结石患者结石清除效果好，术后并发症与常规经皮肾镜取石术无明显差异。输尿管硬镜下钬激光碎石术具有手术时间短、创伤小、术后恢复快等优势，可以减轻炎症反应，降低结石复发率，值得推广。

关键词:

钬激光碎石术, 输尿管硬镜, 复杂性上尿路结石, 炎性反应因子, 并发症, 复发

Feng Chang, Tang Yahua, Ye Guilin.

Efficacy of holmium laser lithotripsy under rigid ureteroscopy in the treatment of complex upper urinary calculi [J]. International Medicine and Health Guidance News, 2024, 30(22): 3816-3820.

冯畅唐亚华叶桂林.

输尿管硬镜下钬激光碎石术治疗复杂性上尿路结石的疗效 [J]. 国际医药卫生导报, 2024, 30(22): 3816-3820.

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