输尿管软硬镜和经皮肾镜对输尿管上段嵌顿性结石疗效分析

Analysis of the Effect of Flexible Ureteroscope Combined with Rigid Ureteroscope and Percutaneous Nephroscopy on the Incarcerated Calculi in the Upper Ureter

摘要: 目的：观察输尿管软硬镜和经皮肾镜对输尿管上段嵌顿性结石的疗效。方法：选取我院收治的110例输尿管上段嵌顿性结石患者，依据治疗方式差异分为输尿管软硬镜组(n = 65)与经皮肾镜组(n = 45)，比较2组术前1 d与术后1 d肾功能[血肌酐(SCr)、明胶酶相关脂质运载蛋白(NGAL)、血尿氮素(BUN)]，并观察2组手术指标、住院时间、并发症情况、结石清除率。结果：术后1 d，2组SCr、BUN水平比较无明显差异(P > 0.05)，输尿管软硬镜组NGAL水平明显高于经皮肾镜组(t = 11.518, P < 0.05)；输尿管软硬镜组术中出血量明显少于经皮肾镜组(t = 55.534, P < 0.05)，手术时间明显长于经皮肾镜组(t = 14.869, P < 0.05)，且住院时间明显短于经皮肾镜组(t = 19.222, P < 0.05)；输尿管软硬镜组术后并发症总发生率10.77%，经皮肾镜组8.89%，差异无统计学意义(x² = 0.000, P > 0.05)；输尿管软硬镜组结石清除率96.92%，经皮肾镜组93.33% (x² = 0.179, P > 0.05)。结论：对输尿管上段嵌顿性结石采取输尿管软硬镜碎石术或者经皮肾镜均能获得良好结石清除效果，术后并发症相当，输尿管软硬镜碎石术具有出血少、术后住院时间短的优势，经皮肾镜对肾功能影响比较小。

Abstract: Objective: To observe the effect of flexible ureteroscope combined with rigid ureteroscope and percutaneous nephroscopy on the incarcerated calculi in the upper ureter. Methods: 110 patients with incarcerated calculi in the upper ureter in our hospital were divided into flexible and rigid ureteroscope group (n = 65) and percutaneous nephroscopy group (n = 45) according to the dif-ference of treatment methods. Renal function [serum creatinine (SCr), gelatinase-associated lipocalin (NGAL), blood urea nitrogen (BUN)] on preoperative 1 d and postoperative 1 d in two groups were compared, and the surgical index, hospitalization time, complications, and stone re-moval rate of the two groups were observed. Results: At 1 day after the surgery, there was no sig-nificant difference in the levels of SCr and BUN between the two groups (P > 0.05); the level of NGAL in flexible and rigid ureteroscope group was significantly higher than that in the percutaneous nephroscopy group (t = 11.518, P < 0.05); the amount of bleeding in flexible and rigid ureteroscope group was significantly less than that in percutaneous nephroscopy group (t = 55.534, P < 0.05); the operation time was significantly longer than the percutaneous nephroscopy group (t = 14.869, P < 0.05); the hospital stay was significantly shorter than percutaneous nephroscopy group (t = 19.222, P < 0.05); the total incidence of flexible and rigid ureteroscope group was 10.77%, 8.89% in the percutaneous nephroscopy group (x² = 0.000, P > 0.05). The stone clearance rate of flexible and rigid ureteroscope group was 96.92%, and that of the percutaneous nephroscopy group was 93.33% (x² = 0.179, P > 0.05). Conclusions: Flexible, rigid ureteroscope lithotomy or percutaneous nephroscopy for incarcerated calculi in the upper ureter can achieve good stone removal effect; postoperative complications are comparable; flexible ureteroscope combined with rigid ureteroscope lithotomy has the advantages of less bleeding and shorter postoperative hospital stay. Percutaneous nephroscopy has a relatively smaller effect on renal function.