一次性电子输尿管软镜分期碎石术治疗方案在2～4cm上尿路结石患者治疗中的应用分析OA

Objective:To explore the application of the one-time electronic flexible ureteroscopy staged lithotripsy treatment plan in the treatment of patients with 2 to 4 cm upper urinary tract calculi.Method:The clinical data of 120 patients with 2 to 4 cm upper urinary tract calculi who underwent one-time electronic flexible ureteroscopic staged lithotripsy and were admitted to Shiyan People's Hospital of Bao'an District,Shenzhen City from June 2024 to June 2025 were selected.The patients with successful first-stage lithotripsy were divided into group A(30 cases),and the patients with second-stage lithotripsy were divided into group B(90 cases).According to the timing of the second-stage surgery of the patients,they were further divided into the 2-week group(Group a),the 3-week group(Group b),and the 4-week group(Group c),with 30 cases in each group.The general information of Group A and Group B were compared.The stone clearance rates of group a,Group b and Group c were compared.The renal function[serum creatinine(SCR)]of the three groups before the operation,1 day after the operation and 7 days after the operation were compared.The incidence of postoperative complications of the three groups was also compared.Result:logistic regression analysis showed that holmium laser energy(1.0 to 1.5 J)was an independent protective factor for secondary lithotripsy in patients,and the difference was statistically significant(P＜0.05).Body mass index(BMI)≥ 24 kg/m2,stones located in the middle/lower calyces,the angle between the renal pelvis and funnel＜90°,and severe hydronephrosis are independent risk factors for stage Ⅱ lithotripsy,and the differences are statistically significant(P＜0.05).The stone clearance rate in group c was higher than that in groups a and b,and the difference was statistically significant(P＜0.05).Before the operation,there was no statistically significant difference in the t-test and F-test of SCR levels among the three groups(P＞0.05).The F-test results of the three groups at 1 day and 7 days after the operation were statistically different(P＜0.05).One day after the operation,the SCR levels in all three groups increased compared with before,but those in group c were lower than those in the other two groups,and the difference was statistically significant(P＜0.05).At 7 days after the operation,the SCR levels in all three groups were lower than those at 1 day after the operation,and the SCR level in group c was lower than that in the other two groups,with statistically significant differences(P＜0.05).The incidence of complications in group c was lower than that in groups a and b,and the difference was statistically significant(P＜0.05).Conclusion:Among patients with 2 to 4 cm upper urinary tract calculi undergoing one-time electronic flexible ureteroscopic staged lithotripsy,holmium laser energy(1.0～1.5 J)is an independent protective factor for the second-stage lithotripsy.The independent risk factors that lead to the need for secondary lithotripsy in patients are BMI≥24 kg/m2,the stone located in the middle/lower calyx,the Angle between the renal pelvis and infunnelium＜90°,and severe hydronephrosis,which can provide a reference for the selection of treatment plans for different patients.Meanwhile,in patients with stage Ⅱ lithotripsy,postponing the operation to 4 weeks can increase the stone clearance rate of patients,promote the recovery of postoperative renal function,and also shorten the operation time and hospital stay,reducing the incidence of postoperative complications.