头端可弯曲负压吸引鞘联合逆行输尿管软镜手术治疗2～3 cm上尿路结石患者的效果OA
Effect of Suction Ureteral Access Sheath Combined with Retrograde Intrarenal Surgery in the Treatment of Patients with 2-3 cm Upper Urinary Tract Calculi
目的:探讨头端可弯曲负压吸引鞘(S-UAS)联合逆行输尿管软镜手术(RIRS)治疗2～3 cm上尿路结石的临床效果.方法:回顾性选取2022年10月—2025年1月扬州洪泉医院收治的98例2～3 cm上尿路结石患者的临床资料.按手术方式分为S-UAS+RIRS组(48 例,行S-UAS联合RIRS治疗)和经皮肾镜取石术(PCNL)组(50 例,行PCNL治疗).比较两组手术相关指标、结石清除率(SFR)、尿液蛋白结合毒素(PBUT)及代谢指标水平,并统计两组并发症发生率.结果:S-UAS+RIRS组手术时间长于PCNL组,住院时间短于PCNL组,术中出血量、术后 1 d Hb较术前下降值,以及术后 1 d WBC、CRP、降钙素原(PCT)较术前升高值、术后 1 d VAS评分低于PCNL组(P<0.05).术后 1 d与术后 1 个月,两组SFR对比,差异无统计学意义(P>0.05).术后 1 个月,两组尿液中硫酸吲哚酚(IS)、尿枸橼酸水平较术前升高,且S-UAS+RIRS组高于PCNL组(P<0.05);术后 1 个月,两组尿酸、尿草酸水平较术前降低,且S-UAS+RIRS组低于PCNL组(P<0.05);术后 1 个月,两组尿液中 3-吲哚乙酸(IAA)、硫酸对甲酚(PCS)较术前降低(P<0.05),但两组组间对比,差异无统计学意义(P>0.05).S-UAS+RIRS组并发症发生率低于PCNL组(P<0.05).结论:S-UAS联合RIRS治疗 2～3 cm上尿路结石的清石效果与PCNL相当,且具有术中出血少、术后恢复快、并发症少的优势;同时在改善患者术后PBUT及代谢指标水平方面具有显著优势,是一种安全有效的微创治疗选择.
Objective:To investigate the clinical efficacy of suction ureteral access sheath(S-UAS)combined with retrograde intrarenal surgery(RIRS)in the treatment of 2-3 cm upper urinary tract calculi.Method:The clinical data of 98 patients with 2-3 cm upper urinary tract calculi admitted to Yangzhou Hongquan Hospital from October 2022 to January 2025 were retrospectively selected.According to the surgical methods,they were divided into S-UAS+RIRS group(48 cases,treated with S-UAS combined with RIRS)and the percutaneous nephrolithotomy(PCNL)group(50 cases,treated with PCNL).The operation related indicators,stone-free rate(SFR),protein-bound uremic toxins(PBUT)and metabolic index levels were compared between the two groups,and the incidence of complications in the two groups was counted.Result:The operation time of S-UAS+RIRS group was longer than that of PCNL group,and the length of hospital stay was shorter than that of PCNL group,the intraoperative blood loss,the decrease in Hb 1 day after the operation compared to before the operation,the increase in WBC,CRP,procalcitonin(PCT)1 day after the operation compared to before the operation,and the VAS score 1 day after the operation were lower than those of the PCNL group(P<0.05).There were no significant differences in SFR between the two groups at 1 day and 1 month after operation(P>0.05).One month after operation,the levels of indoxyl sulfate(IS)in the urine and urinary citrate in the two groups were higher than those before operation,and those in the S-UAS+RIRS group were higher than those in the PCNL group(P<0.05).One month after operation,the levels of uric acid and urinary oxalic acid in the two groups were lower than those before operation,and the levels in S-UAS+RIRS group were lower than those in PCNL group(P<0.05).One month after operation,the 3-indolylacetic acid(IAA)and p-cresyl sulfate(PCS)in the urine in the two groups were lower than those before operation(P<0.05),but there were no significant differences between the two groups(P>0.05).The incidence of complications in S-UAS+RIRS group was lower than that in PCNL group(P<0.05).Conclusion:S-UAS combined with RIRS in the treatment of 2-3 cm upper urinary tract calculi has the same effect as PCNL,and has the advantages of less intraoperative bleeding,faster postoperative recovery and fewer complications.At the same time,it has significant advantages in improving the level of PBUT and metabolic indicators,and is a safe and effective minimally invasive treatment option.
吴石;姚浩;朱从武;李民
扬州洪泉医院泌尿外科 江苏 扬州 225200扬州大学附属苏北人民医院泌尿外科 江苏 扬州 225001扬州洪泉医院泌尿外科 江苏 扬州 225200扬州洪泉医院泌尿外科 江苏 扬州 225200
医药卫生
头端可弯曲负压吸引鞘逆行输尿管软镜手术经皮肾镜取石术上尿路结石尿液蛋白结合毒素结石清除率
Suction ureteral access sheathRetrograde intrarenal surgeryPercutaneous nephrolithotomyUpper urinary tract calculiProtein-bound uremic toxinsStone-free rate
《中国医学创新》 2026 (20)
40-45,6
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