不同年资医生行输尿管软镜钬激光碎石术的疗效分析

Analysis of Curative Effect of Flexible Ureteroscope Holmium Laser Lithotripsy Performed by Doctors with Different Seniority

摘要: 目的：探讨不同年资的医生行输尿管软镜钬激光碎石术(RIRS)的临床疗效。方法：回顾性分析我院2020年6月至2022年1月行RIRS的139例上尿路结石患者的临床资料。男82例，女57例，年龄(48.83 ± 12.17)岁。结石最大CT值(1107.76 ± 356.83) HU，结石最大径(15.01 ± 6.12) mm。单侧肾结石47例，双肾结石8例，单侧输尿管上段结石62例，单侧输尿管上段结石合并肾结石22例。28例术前留置双J管。术前血白细胞(WBC) (6.84 ± 2.41) × 10^9/L，降钙素原(PCT) (1.27 ± 0.83) ng/ml。手术均采用全麻，患者取截石位。采用输尿管软镜联合钬激光碎石，软镜顺利进入肾盂后首先观察肾盂及各肾盏并寻及结石。使用200 μm光纤碎石，钬激光功率为15~45 w (0.8~1.8 J)，根据实际情况辅助取石网篮套取结石。术中检查各肾盂、肾盏，确保结石已完全粉末化，碎石结束留置双J管和尿管。手术随机由不同年资的术者完成。结果：所有手术均顺利完成，手术时间(86.71 ± 30.51) min，两组手术时间比较差异无统计学意义(t = 0.499, p = 0.063)。术中出血量(47.80 ± 22.86) ml，两组术中出血量比较差异无统计学意义(t = 1.183, p = 0.068)。术后第1天复查血WBC计数(6.84 ± 2.41) × 10^9/L，与术前比较差异有统计学意义(t = 1.127，p < 0.05)，两组术后WBC计数比较差异无统计学差异(t = 0.925, p = 0.128)；PCT (1.27 ± 0.83) ng/ml，与术前比较差异有统计学意义(t = 1.112, p < 0.05)，两组术后PCT比较差异无统计学差异(t = 0.964, p = 0.923)。住院时间(6.59 ± 2.47) d，两组住院时间比较差异无统计学意义(t = 0.672, p = 0.632)。术后返院拔双J管均获得随访，结石清除率(stone-free rate, SFR) 100%。结论：RIRS是上尿路中小结石患者的一种疗效确切的治疗方式，随着输尿管软镜国产化，RIRS操作简单、安全性高的优点，RIRS可向基层医院广泛推广。

Abstract: Objective: The clinical efficacy of flexible ureteroscopic holmium laser lithotripsy (RIRS) performed by doctors of different seniority. Methods: The clinical data of 139 patients with upper urinary tract calculi who underwent RIRS in our hospital from June 2020 to January 2022 were retrospectively analyzed. There were 82 males and 57 females, aged (48.83 ± 12.17) years old. The maximum CT value of the stone was (1107.76 ± 356.83) HU, and the maximum stone diameter was (15.01 ± 6.12) mm. There were 47 cases of unilateral renal calculi, 8 cases of bilateral renal calculi, 62 cases of unilateral upper ureteral calculi, and 22 cases of unilateral upper ureteral calculi combined with renal calculi. Twenty-eight cases were preoperatively indwelled with double J tubes. Preoperative white blood cells (WBC) (6.84 ± 2.41) × 10^9/L, procalcitonin (PCT) (1.27 ± 0.83) ng/ml. All operations were performed under general anesthesia, and the patients were in the lithotomy position. The flexible ureteroscopy combined with holmium laser lithotripsy was used. After the flexible scope successfully entered the renal pelvis, the renal pelvis and the renal calyces were first observed and the calculi were found. Use 200 μm fiber lithotripsy, holmium laser power of 15~45 w (0.8~1.8 J), and assist the stone extraction basket to extract stones according to the actual situation. During the operation, the renal pelvis and renal calyces were checked to ensure that the stones had been completely powdered, and the double J tube and the urinary catheter were indwelled at the end of the stone crushing. The operations were performed randomly by surgeons with different seniority. Results: All operations were successfully completed, and the operation time was (86.71 ± 30.51) minutes. There was no sig-nificant difference in operation time between the two groups (t = 0.499, p = 0.063). The intraoperative blood loss was (47.80 ± 22.86) ml, and there was no significant difference in intraoperative blood loss between the two groups (t = 1.183, p = 0.068). The blood WBC count was re-examined on the 1st day after operation (6.84 ± 2.41) × 10^9/L, and the difference was statistically significant compared with that before operation (t = 1.127, p < 0.05). There was no statistical difference in WBC count between the two groups after operation. PCT (1.27 ± 0.83) ng/ml, the difference was statistically significant (t = 1.112, p < 0.05), and there was no statistical difference in postoperative PCT between the two groups’ academic difference (t = 0.964, p = 0.923). The length of hospital stay was (6.59 ± 2.47) days, and there was no significant difference in the length of hospital stay between the two groups (t = 0.672, p = 0.632). All patients were followed up after returning to the hospital to remove the double-J tube, and the stone-free rate (SFR) was 100%. Conclusions: RIRS is an effective treatment method for patients with small and medium stones in the upper urinary tract. With the localization of flexible ureteroscopy, RIRS has the advantages of simple operation and high safety. RIRS can be widely promoted in primary hospitals.