FURS与PCNL治疗肾结石疗效比较_薛向东.pdf

分子诊断与治疗杂志2023年1月第15卷第1期J Mol Diagn Ther,January 2023,Vol.15No.1论著基金项目：新乡医学院第一附属医院青年基金项目（QN2017B006）作者单位：新乡医学院第一附属医院泌尿外科，河南，卫辉 453000通信作者：朱峰，Email：FURS与PCNL治疗肾结石疗效比较薛向东余沁楠张会清朱峰摘要 目的研究软性输尿管镜下钬激光碎石术（FURS）与经皮肾镜钬激光碎石术（PCNL）对直径2 cm肾结石患者术后结石清除率及可溶性血管细胞黏附分子1（sVCAM1）、肾损伤分子1（KIM1）水平的影响。方法选择新乡医学院第一附属医院泌尿外科2020年5月至2022年5月收治的肾结石患者85例，根据其手术方式将其分为FURS组（n=45）和PCNL组（n=40），其中FURS组采用软性输尿管镜下钬激光碎石术（FURS）治疗，而PCNL 组则采用经皮肾镜钬激光碎石术（PCNL）治疗。观察两组患者手术时间、下床活动时间、术中失血量、血红蛋白下降值、住院时间、结石清除率和并发症发啥情况，统计术前和术后血清sVCAM1、血沉（ESR）和尿液KIM1含量，记录术前及术后疼痛视觉模拟量表（VAS）、威斯康辛生活质量问卷（WISQOL）评分。结果FURL 组手术时间明显高于 PCNL 组，差异有统计学意义（t=7.438，P0.05）；但其下床活动时间、术中失血量、血红蛋白下降值、住院时间均显著低于PCNL组，差异有统计学意义（t=17.262、17.583、29.295、7.571，P0.05）。FURL 组术后结石清除率高于 PCNL 组，术后并发症发生率均低于PCNL组，差异有统计学意义（2=3.995、6.177，P0.05）。FURL组术后血清sVCAM1含量、尿液KIM1含量、VAS评分低于PCNL组，差异有统计学意义（t=15.727、4.490、4.561，P0.05）；FURL组术后ESR、WISQOL评分高于PCNL组，差异有统计学意义（t=3.250、2.016，P0.05）。结论采用FURS治疗直径2 cm肾结石效果较好，且能缩短术后康复时间，同时对血清sVCAM1、ESR和尿液KIM1影响较小，有助于术后生活质量的改善。关键词 直径2 cm肾结石；软性输尿管镜钬激光碎石术；经皮肾镜钬激光碎石术；结石清除率；sVCAM1；KIM1Furs versus PCNL in the treatment of kidney stonesXUE Xiangdong，YU Qinnan，ZHANG Huiqing，ZHU Feng（Department of Urology，the First Affiliated Hospital of Xinxiang Medical College，Weihui，Henan，China，453000）ABSTRACTObjectiveTo study the effect of flexible ureteroscopic holmium laser lithotripsy（FURS）and percutaneous nephroscopic holmium laser lithotripsy（PCNL）on postoperative stone clearanceand soluble vascular cell adhesion molecule1（sVCAM1）in patients with kidney stones with a diameter of 2cm，the effect of kidney injury molecule1（KIM1）levels.MethodsA total of 85 patients with kidney stonesadmitted to the Urology Department of the First Affiliated Hospital of Xinxiang Medical College from May2020 to May 2022 were selected and divided into the FURS group（n=45）and the PCNL group（n=40）according to their surgical methods.，the FURS group was treated with flexible ureteroscopic holmium laser lithotripsy（FURS），while the PCNL group was treated with percutaneous nephroscopic holmium laser lithotripsy（PCNL）.The operation time，time of getting out of bed，intraoperative blood loss，hemoglobin drop，hospitalization time，stone clearance rate and complications were observed in the two groups of patients，and the preoperative and postoperative serum sVCAM1，erythrocyte sedimentation rate（ESR）and Urine KIM1 content，preoperative and postoperative pain Visual Analog Scale（VAS）and Wisconsin Quality of Life Questionnaire（WISQOL）scores were recorded.ResultsThe operation time in the FURL group was significantly longer 132DOI:10.19930/ki.jmdt.2023.01.033分子诊断与治疗杂志2023年1月第15卷第1期J Mol Diagn Ther,January 2023,Vol.15No.1than that in the PCNL group，and the difference was statistically significant（t=7.438，P0.05）.However，theirtime to bed activity，intraoperative blood loss，hemoglobin drop values，and hospital stay were significantlylower than those in the PCNL group，with statistically significant differences（t=17.262，17.583，29.295，7.571，P0.05）.The stone clearance rate in the FUL group was higher than that in the PCNL group，and the incidence of postoperative complications was lower than that in the PCNL group，the difference was statisticallysignificant（2=3.995，6.177，P0.05）.The postoperative serum sVCAM1 content，urine KIM1 content andVAS score in the FURL group were lower than those in the PCNL group，and the differences were statisticallysignificant（t=15.727，4.490，4.561，P0.05）.The postoperative ESR，WISQOL scores in the FURL groupwere higher than those in the PCNL group，and the difference was statistically significant（t=3.250，2.016，P0.05）.ConclusionThe effect of FURS in the treatment of kidney stones with a diameter 2 cm is better，andit can shorten the postoperative recovery time.At the same time，it has little effect on serum sVCAM1，ESRand urine KIM1，which helps to improve the quality of life after surgery.KEY WORDS Kidney stones 2 cm in diameter；Flexible ureteroscopic holmium laser lithotripsy；Percutaneous nephroscopic holmium laser lithotripsy；Stone clearance rate；Soluble vascular cell adhesion molecule1；Kidney injury molecule1经皮肾镜钬激光碎石术（percutaneous nephrolithotomy，PCNL）作为大直径肾结石主要治疗方案，但对于异位结石治疗穿刺通道选择略显困难，且术后易出现各种严重并发症。软性输尿管镜下钬激光碎石术（flexible ureteroscopy，FURS）作为近年兴起的一种腔镜技术，使用的软性输尿管镜末端兼具主动和被动弯曲功能，能方便进入各个肾盏，检查整个肾集合系统，同时还可避免PCNL 造成的大面积创伤12。可溶性血管细胞黏附分子1（soluble vascular cell adhension moleculel，sVCAM1）在淋巴细胞粘附到炎症内皮过程中发挥重要作用；红细胞沉降速度（erythrocyte sedimentation rate，ESR）是反映红细胞聚集性的常用指标，还可以用于监测早期感染。肾损伤分子1（kidney injury molecule1，KIM1）在缺血及毒性肾损伤后的近曲小管上皮细胞表达显著升高，且不受尿液理化性质改变的影响。因此，本研究对直径2 cm 肾结石选用 FURS 和 PCNL 治疗患者进行对比分析。1资料与方法1.1一般资料选择新乡医学院第一附属医院 2020 年 5 月至2022 年 5 月收治的肾结石患者 85 例，根据其手术方式将其分为 FURS 组（n=45）和 PCNL 组（n=40）。FURS 组男性 28 例、女性 17 例；年龄平均（42.115.36）岁；肾结石直径平均（2.740.21）cm；肾结石类型：肾盂结石 5 例、下盏结石 9 例、中盏结石 14 例、上盏结石 17 例；肾结石部位：左侧 25 例、右侧 20 例。PCNL 组男性 24 例、女性 16 例；年龄平均（42.485.19）岁；肾结石直径平均（2.690.25）cm；肾结石类型：肾盂结石 3 例、下盏结石 8例、中盏结石 12 例、上盏结石 16 例、肾结石部位：左侧 22 例、右侧 18 例。本研究经院医学伦理委员会批准通过。纳入标准：术前常规行泌尿系影像学检查（B 超、平片、CT、磁共振尿路成像）等确诊为肾结石，且结石直径2 cm；均为单侧肾患有结石患者，术前血尿素氮、血肌酐含量正常；手术和麻醉耐受力均良好，术前