輸尿管軟鏡與經皮腎鏡碎石術治療較大腎輸尿管結石的臨床療效及對并發癥的影響

摘要：目的" 比較輸尿管軟鏡與經皮腎鏡碎石術治療較大腎輸尿管結石的臨床療效及對并發癥的影響。方法" 選取2020年6月-2023年6月鉛山縣人民醫院收治的較大腎輸尿管結石患者60例為研究對象，根據隨機數字表法將其分成對照組和觀察組，每組30例，對照組行經皮腎鏡碎石術，觀察組行輸尿管軟鏡碎石術。比較兩組手術指標（手術時間、術中出血量、留置導尿管時間、住院時間）、應激反應指標[中性粒細胞明膠酶相關脂質運載蛋白（NGAL）、超氧化物歧化酶（SOD）、丙二醛（MDA）]、炎癥反應[白細胞介素-10（IL-10）、C反應蛋白（CRP）和白細胞計數（WBC）]和并發癥（輸尿管水腫、血尿、腎包膜下血腫）發生率。結果" 觀察組手術時間長于對照組，術中出血量、留置導尿管時間、住院時間短于對照組（Plt;0.05）。術后24 h，觀察組nGAL、MDA水平低于對照組，SOD水平高于對照組（Plt;0.05）。觀察組IL-10、CRP及WBC水平均低于對照組（Plt;0.05）。觀察組并發癥發生率低于對照組（Plt;0.05）。結論" 輸尿管軟鏡與經皮腎鏡碎石術治療較大腎輸尿管結石的臨床療效都較好，但輸尿管軟鏡碎石術對患者手術創傷更小，術后應激反應程度以及并發癥發生率低，不會給患者帶來較強的損傷或炎癥反應。

關鍵詞：輸尿管軟鏡碎石術;經皮腎鏡碎石術;腎結石;應激反應;炎癥反應

中圖分類號：R692.4" " " " " " " " " " " " " " " " " 文獻標識碼：A" " " " " " " " " " " " " " " " DOI：10.3969/j.issn.1006-1959.2025.01.018

文章編號：1006-1959（2025）01-0101-05

Clinical Efficacy of Flexible Ureteroscope and Percutaneous Nephrolithotripsy in the Treatment"of Larger Renal and Ureteral Calculi and its Influence on Complications

ZHENG Jiren

（Urology Department of Yanshan County People's Hospital， Yanshan 334500， Jiangxi， China）

Abstract： Objective" To compare the clinical efficacy and complications of flexible ureteroscopy and percutaneous nephrolithotomy in the treatment of large renal and ureteral calculi. Methods" A total of 60 patients with large renal and ureteral calculi admitted to Yanshan County People′s Hospital from June 2020 to June 2023 were selected as the research objects. According to the random number table method， they were divided into control group and observation group， with 30 patients in each group. The control group underwent percutaneous nephrolithotripsy， and the observation group underwent flexible ureteroscopic lithotripsy. The operation indexes （operation time， intraoperative blood loss， indwelling catheter time， hospitalization time）， stress response indexes [neutrophil gelatinase-associated lipocalin （NGAL）， superoxide dismutase （SOD）， malondialdehyde （MDA）]， inflammatory response [interleukin-10 （IL-10）， C-reactive protein （CRP） and white blood cell count （WBC）] and the incidence of complications （ureteral edema， hematuria， renal subcapsular hematoma） were compared between the two groups. Results" The operation time of the observation group was longer than that of the control group， and the intraoperative blood loss， indwelling catheter time and hospitalization time were shorter than those of the control group （Plt;0.05）. At 24 h after operation， the levels of nGAL and MDA in the observation group were lower than those in the control group， and the level of SoD was higher than that in the control group （Plt;0.05）. The levels of IL-10， CRP and WBC in the observation group were lower than those in the control group （Plt;0.05）. The incidence of complications in the observation group was lower than that in the control group （Plt;0.05）. Conclusion" The clinical efficacy of flexible ureteroscopy and percutaneous nephrolithotomy in the treatment of large renal and ureteral calculi is better， but flexible ureteroscopy lithotripsy has less surgical trauma， lower postoperative stress response and lower incidence of complications， and will not bring strong damage or inflammatory response to patients.

Key words：Ureteroscope; Percutaneous nephrolithotripsy; Renalcalculi; Stress reaction; Inflammatory response

腎結石及輸尿管結石指的是尿酸、草酸、鈣、胱氨酸等晶體物質異常聚積在腎臟及輸尿管所導致的一種泌尿系疾病。在泌尿系統疾病中，較大腎輸尿管結石屬于常見的多發病，以草酸鈣結石最為常見，男性的發病率高于女性，臨床表現為血尿、腰痛等不適癥狀[1]。……