[1]刘彦军,景治安,毛长青,等.软性与硬性输尿管镜钬激光碎石术治疗输尿管结石伴输尿管狭窄疗效比较[J].新乡医学院学报,2020,37(10):976-979.[doi:10.7683/xxyxyxb.2020.10.017]
　LIU Yanjun,JING Zhian,MAO Changqing,et al.Comparison of the effect of holmium laser lithotripsy under flexible and rigid ureteroscope in the treatment of ureteral calculus combined with ureteric stenosis[J].Journal of Xinxiang Medical University,2020,37(10):976-979.[doi:10.7683/xxyxyxb.2020.10.017]
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软性与硬性输尿管镜钬激光碎石术治疗输尿管结石伴输尿管狭窄疗效比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
37
期数:
2020年10
页码:
976-979
栏目:
临床研究
出版日期:
2020-10-05

文章信息/Info

Title:
Comparison of the effect of holmium laser lithotripsy under flexible and rigid ureteroscope in the treatment of ureteral calculus combined with ureteric stenosis
作者:
刘彦军; 景治安; 毛长青; 李纪华; 胡和平
（郑州市第一人民医院泌尿外科，河南　郑州　450004）
Author(s):
LIU Yanjun; JING Zhian; MAO Changqing; LI Jihua; HU Heping
(Department of Urology，Zhengzhou First People′s Hospital，Zhengzhou 450004，Henan Province，China)
关键词:
软性输尿管镜; 硬性输尿管镜; 钬激光碎石术; 输尿管结石; 输尿管狭窄
Keywords:
flexible ureteroscope; rigid ureteroscope; holmium laser lithotripsy; ureteral calculus; ureteric stenosis
分类号:
R691.4
DOI:
10.7683/xxyxyxb.2020.10.017
文献标志码:
A
摘要:
目的　比较软性与硬性输尿管镜钬激光碎石术治疗输尿管结石伴输尿管狭窄的临床效果。方法　选择2016年9月至2017年11月郑州市第一人民医院收治的65例输尿管结石伴输尿管狭窄患者为研究对象，按照治疗方式将患者分为软性输尿管镜组（n=45）和硬性输尿管镜组（n=20）。硬性输尿管镜组患者行硬性输尿管镜钬激光碎石术，软性输尿管镜组患者行软性输尿管镜钬激光碎石术。观察2组患者手术时间、住院时间、结石排出情况及术后并发症，分别于术前及术后第1、3、5天检测患者血清肿瘤坏死因子-α（TNF-α）和白细胞介素-10（IL-10）水平。结果　软性输尿管镜组患者的手术时间和住院时间分别为（39.5±0.8）min、（7.2±1.2）d，硬性输尿管镜组患者的手术时间和住院时间分别为（57.1±2.3）min、（7.9±0.8）d；软性输尿管镜组患者的手术时间显著短于硬性输尿管镜组（P<0.05），2组患者的住院时间比较差异无统计学意义（P>0.05）。软性输尿管镜组和硬性输尿管镜组患者结石排尽率分别为93.3%（42/45）、90.0%（18/20），2组患者的结石排尽率比较差异无统计学意义（χ2=0.002，P>0.05）。术前2组患者血清TNF-α、IL-10水平比较差异无统计学意义（P>0.05）；2组患者术后第1天血清TNF-α、IL-10水平显著高于术前，术后第3、5天血清TNF-α、IL-10水平显著低于术后第1天，术后第5天血清TNF-α、IL-10水平显著低于术后第3天（P<0.05）；术后第1、3、5天，软性输尿管镜组患者血清TNF-α、IL-10水平显著低于硬性输尿管镜组（P<0.05）。软性输尿管镜组和硬性输尿管镜组患者术后并发症发生率分别为4.44%（2/45）、15.00%（3/20），软性输尿管镜组患者术后并发症发生率显著低于硬性输尿管镜组（χ2=6.163，P<0.05）。结论　软性和硬性输尿管镜钬激光碎石术治疗输尿管结石伴输尿管狭窄均可获得较高的结石排尽率，但软性输尿管镜钬激光碎石术手术时间短，可减轻机体炎症反应，降低术后并发症发生率。
Abstract:
Objective　To compare the clinical effect of holmium laser lithotripsy under flexible and rigid ureteroscope in the treatment of ureteral calculus combined with ureteric stenosis.Methods　Sixty-five patients with ureteral calculus combined with ureteric stenosis admitted to Zhengzhou First People′s Hospital from September 2016 to November 2017 were selected as the research subjects，and the patients were divided into flexible ureteroscope group (n=45) and rigid ureteroscope group (n=20) according to the treatment methods.The patients in the rigid ureteroscope group were treated with holmium laser lithotripsy under rigid ureteroscopy，and the patients in the flexible ureteroscope group were treated with holmium laser lithotripsy under flexible ureteroscopy.The operation time，hospitalization time，stone discharge and postoperative complications were observed.The levels of serum tumor necrosis factor-α (TNF-α) and interleukin-10 (IL-10) were measured before operation and on the first，third and fifth day after operation.Results　The operation time and the hospitalization time in the flexible ureteroscope group were (39.5±0.8) min and (7.2±1.2) d，respectively.The operation time and the hospitalization time in the rigid ureteroscope group were (57.1±2.3) min and (7.9±0.8) d，respectively.The operation time in the flexible ureteroscope group was significantly shorter than that in the rigid ureteroscope group (P<0.05)，and there was no significant difference in the hospitalization time between the two groups (P>0.05).The stone clearance rate in the flexible ureteroscope group and rigid ureteroscope group was 93.3%(42/45) and 90%(18/20)，respectively.There was no significant difference in stone clearance rate between the two groups (χ2=0.002，P>0.05).There was no significant difference in serum TNF-α and IL-10 levels between the two groups before operation (P>0.05).In the two groups，the levels of serum TNF-α and IL-10 on the first day after operation were significantly higher than those before operation，the levels of serum TNF-α and IL-10 on the third and fifth day after operation were significantly lower than those on the first day after operation，and the levels of serum TNF-α and IL-10 on the fifth day after operation were significantly lower than those on the third day after operation(P<0.05).The levels of serum TNF-α and IL-10 in the flexible ureteroscope group were significantly lower than those in the rigid ureteroscope group on the first，third and fifth day after operation(P<0.05).The incidence of postoperative complications in the flexible ureteroscope group and the rigid ureteroscope group was 4.44% (2/45) and 15.00% (3/20)，respectively.The incidence of post-operative complications in the flexible ureteroscope group was significantly lower than that in the rigid ureteroscope group (χ2=6.163，P<0.05).Conclusion　The holmium laser lithotripsy under flexible and rigid ureteroscope in the treatment of ureteral calculus combined with ureteric stenosis can achieve high stone clearance rate，but the operation time of holmium laser lithotripsy under flexible ureteroscope is short，which can reduce the inflammatory reaction and the incidence of postoperative complications.

参考文献/References:

［1］　王晖，陆鸿海，张炳辉，等.输尿管结石合并狭窄的治疗策略［J］.同济大学学报（医学版），2016，37（1）：93-96.
［2］　GHOSH B，JAIN P，PAL D K，et al.Managing mid and lower ureteral benign strictures：the laparoscopic way［J］.J Laparoendosc Adv Surg Tech A，2018,28(1):25-32.
［3］　叶照华，米其武，罗杰鑫.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］.中华腔镜泌尿外科杂志：电子版，2017，11（1）：46-48.DOI：10.3877/cma.j.issn.1674-3253.2017.01.011.
［4］　李武学，赵兴华，许长宝，等.输尿管镜治疗复杂性输尿管结石留置双J管时间的临床观察［J］.实用医学杂志，2017，33（2）：256-258.
［5］　龙清志，李翔，贺大林，等.输尿管镜碎石术治疗肾和输尿管结石2150例的并发症分析［J］.现代泌尿外科杂志，2016，21（8）：606-609.
［6］　DE CONINCK V，KELLER E X，RODRGUEZ-MONSALVE M，et al.Systematic review of ureteral access sheaths：facts and myths［J］.BJU Int，2018,122(6):959-969.
［7］　徐磊，车宪平，古军.经皮肾镜碎石术联合输尿管软镜治疗老年输尿管上段嵌顿性结石疗效观察［J］.新乡医学院学报，2018，35（7）：597-600.
［8］　任双全，马玉田.输尿管镜下钬激光碎石治疗泌尿系结石疗效评价［J］.深圳中西医结合杂志，2016，26（18）：107-109.
［9］　何建松，叶利洪，陈永良，等.输尿管镜下钬激光碎石术失败的原因与处理［J］.浙江创伤外科，2017，22（3）：499-501.
［10］　秦远，唐龙龙，杨明，等.F6.0/7.5输尿管镜下钬激光碎石术治疗输尿管结石的临床疗效［J］.江苏医药，2019，45（12）：1239-1242.
［11］　高建国，王荣江，沈悦凡，等.体外碎石失败后行输尿管软镜治疗回顾性分析［J］.中国现代医生，2019，57（7）：48-51，55.
［12］　陈文成，潘翔，陈志雄，等.输尿管硬镜碎石术与软镜碎石术术后尿道狭窄情况的临床研究［J］.中国实用医药，2019，14（4）：50-51.
［13］　王小波.输尿管软镜钬激光碎石术治疗输尿管结石的效果研究［J］.当代医药论丛，2018，16（7）：129-130.
［14］　何文强，屈颖伟，郑聪，等.顺行输尿管软镜治疗输尿管中下段结石合并远端输尿管复杂病变［J］.临床泌尿外科杂志，2019，34（7）：542-544.
［15］　郑彬，张贺庆，顾志文，等.输尿管软镜钬激光碎石取石术并发症的原因及对策［J］.微创泌尿外科杂志，2019，8（4）：252-256.
［16］　张喜荣，姜庆，于圣杰，等.输尿管软镜联合碎石术同期治疗双侧上尿路结石患者的临床研究［J］.重庆医学，2017，46（28）：3917-3919.
［17］　陈猛，郁全胜，陈志永，等.顺行输尿管软镜治疗复杂性输尿管结石中下段9例报告［J］.中国内镜杂志，2017，23（3）：104-106.

更新日期/Last Update: 2020-10-05