曲安奈德局部注射联合钬激光治疗嵌顿性输尿管结石的疗效评价

Clinical Evaluation of Local Triamcinolone Injection Combined with Holmium Laser in the Treatment of Incarcerated Ureteral Calculi

摘要: 目的：评价钬激光碎石联合曲安奈德局部注射治疗嵌顿性输尿管结石的治疗效果及对术后并发症发生几率的影响。方法：选取2023年03月~2024年08月于枣庄市立医院泌尿外科住院并确诊为嵌顿性输尿管结石的患者36例。按照就诊顺序对患者进行编号，随后采用随机数表法将患者分为对照组与试验组，其中对照组常规进行输尿管镜钬激光碎石术，试验组在对照组的基础上于碎石后在结石嵌顿部位进行曲安奈德局部注射。评价并记录所有受试者基本情况、术前指标、围术期指标、术后并发症发生情况，拟证明局部注射曲安奈德在输尿管镜钬激光碎石术中具有提高手术成功率、降低术后并发症发生率的作用。结果：本研究中36例患者手术均顺利完成。两组患者在年龄、性别、结石大小、结石位置、术前肌酐、术前肾盂宽度等基本资料方面无统计学差异。对比围术期数据：术中出血量、下床活动时间、尿管留置时间、D-J管拔除时间，两组患者无统计学意义(P > 0.05)。对照组术后肾盂宽度(19.77 ± 7.35 mm)，术后肌酐(74.68 ± 22.86 μmol/L)，试验组术后肾盂宽度(15.25 ± 5.59 mm)，术后肌酐(61.29 ± 10.42 μmol/L)。试验组术后肾盂宽度和肌酐均小于对照组，差异有统计学意义(P < 0.05)。对照组术后并发症3例，试验组术后并发症2例，两者差异无统计学意义(P > 0.05)。结论：1. 试验组术后肾盂宽度及术后肌酐小于对照组；2. 试验组术后肾盂积水和肾功能恢复优于对照组；3. 试验组和对照组术后并发症无明显差异；曲安奈德局部注射联合钬激光治疗嵌顿性输尿管结石安全、有效、可行。

Abstract: Objective: To evaluate the therapeutic efficacy of holmium laser lithotripsy combined with local injection of tretinoin in the treatment of embedded ureteral stones and its effect on the chance of postoperative complications. Methods: Between March 2023 and August 2024, 36 patients with impacted ureteral stones admitted to the Department of Urology at Zaozhuang People’s Hospital were included in the study. Patients were numbered in the order of their admission and then randomly assigned to either the control group or the experimental group using a random number table. The control group received conventional neodymium laser lithotripsy combined with ureteroscopy. The experimental group, in addition to the control group’s treatment, received local injection of vitamin A acid at the site of the impacted stone following lithotripsy. The basic characteristics, preoperative indicators, perioperative indicators, and postoperative complications of all participants were assessed and recorded, aiming to demonstrate that local injection of vitamin A acid can improve the success rate of ureteroscopy neodymium laser lithotripsy and reduce the incidence of postoperative complications. Results: In this study, all 36 patients underwent successful surgery. There were no statistically significant differences between the two groups in terms of baseline data, including age, gender, stone size, stone location, preoperative serum creatinine levels, and preoperative renal pelvis width. When comparing perioperative data, including intraoperative blood loss, time to ambulation, catheterization duration, and D-J stent removal time, there were no statistically significant differences between the two groups (P > 0.05). The postoperative renal pelvis width in the control group was 19.77 ± 7.35 mm, and the postoperative serum creatinine level was 74.68 ± 22.86 μmol/L; in the experimental group, the postoperative renal pelvis width was 15.25 ± 5.59 mm, and the postoperative serum creatinine level was 61.29 ± 10.42 μmol/L. The postoperative renal pelvis width and serum creatinine level in the experimental group were both lower than those in the control group, and the differences were statistically significant (P < 0.05). The incidence of postoperative complications was 3 cases in the experimental group and 2 cases in the control group, with no statistically significant difference between the two groups (P > 0.05). Conclusion: 1. The postoperative renal pelvis width and postoperative creatinine of the experimental group were smaller than those of the control group; 2. The postoperative pyelonephrosis and renal function recovery of the experimental group were better than those of the control group; 3. There was no significant difference in the postoperative complications between the experimental group and the control group; tretinoin topical injection combined with holmium laser treatment of embedded ureteral stones is safe, effective and feasible.