体外物理振动排石联合钬激光碎石治疗上尿路结石的效果观察-现代医学

体外物理振动排石联合钬激光碎石治疗上尿路结石的效果观察

单位：盐城市第三人民医院泌尿外科, 江苏盐城 224100

分类号：R692. 4； R693. 4

出版年·卷·期（页码）：2024·52·第三期（440-445）

摘要：

目的：探究体外物理振动排石联合钬激光碎石对上尿路结石的治疗效果。方法：回顾性分析2020年4月至2023年4月在我院收治的300例上尿路结石患者的临床资料，应用随机数字法将研究对象分为对照组(n=150)和联合组(n=150)。对照组给予钬激光碎石治疗，联合组给予体外物理振动排石联合钬激光碎石治疗。比较两组手术情况、手术前后肾功能、皮质醇(cortisol, Cor)、去甲肾上腺素(norepinephrine, NE)水平、术后排石效果及并发症。结果：两组患者的手术时间、术中出血量比较，差异无统计学意义(t=0.425、0.534, P>0.05)；联合组的住院时间、尿液转清时间、首次下床时间均短于对照组，差异有统计学意义(t=14.357、34.655、51.382,均P＜0.05)。治疗后，联合组的肌酐(creatinine, Cr)、尿素氮(blood urea nitrogen, BUN)、胱抑素C(cystatin C, CysC)、尿酸(uric acid, UA)、Cor和NE水平均低于对照组，差异有统计学意义(t=12.513、15.342、10.430、7.065、11.748、15.180,均P＜0.05)。联合组患者的一次性碎石清石率、术后1周清石率、术后一个月清石率、术后两个月清石率均高于对照组，差异有统计学意义(χ²=7.623、4.403、4.511、7.114,均P＜0.05)；联合组患者的并发症总发生率低于对照组(χ²=5.146，P＜0.05)。结论：体外物理振动排石联合钬激光碎石对上尿路结石有着显著效果，提高了排石效果，降低了并发症，建议推广应用。

Objective: To explore the therapeutic effects of extracorporeal physical vibrational lithotripsy combined with holmium laser lithotripsy on upper urinary tract stones.Methods: A retrospective analysis was conducted on 300 patients with upper urinary tract stones treated in our hospital from April 2020 to April 2023. The subjects were divided into a control group(n=150) and a combined group(n=150) using a random number method. The control group received holmium laser lithotripsy treatment, while the combined group was treated with extracorporeal physical vibrational lithotripsy combined with holmium laser lithotripsy. Two groups were compared in terms of surgical conditions, pre-and post-operative kidney function, levels of cortisol(Cor) and norepinephrine(NE), stone expulsion outcomes, and complications.Results: There was no significant difference between the two groups in terms of operation time and intraoperative blood loss(t=0.425, 0.534, P>0.05); however, the duration of hospitalization, time to urine clearance, and time to first ambulation were shorter in the combined group than in the control group, and the difference was statistically significant(t=14.357, 34.655, 51.382, all P＜0.05). After treatment, levels of creatinine(Cr), blood urea nitrogen(BUN), cystatin C(CysC), uric acid(UA), Cor and NE in the combined group were lower than those in the control group(t=12.513, 15.342, 10.430, 7.065, 11.748,15.180,all P＜0.05). The rates of successful stone clearance at the first attempt, after one week, one month, and two months post-operation were all higher in the combined group, with difference was statistically significant(χ²=7.623, 4.403, 4.511, 7.114, all P＜0.05); the overall incidence of complications in the combined group was lower than that in the control group(χ²=5.146, P＜0.05).Conclusion: Extracorporeal physical vibrational lithotripsy combined with holmium laser lithotripsy has a significant effect on upper urinary tract stones, improving stone expulsion outcomes and reducing complications, and is recommended for widespread application.

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