Li Dong, Yu Jinfeng, Chen Yirun, Xu Jia'neng, Zhang Jinfeng
Department of Urinary Surgery, The First People's Hospital of Jiashan Jiaxing, Zhejiang, China.
Department of Urinary Surgery, Jiashan County Chinese Medicine Hospital Jiaxing, Zhejiang, China.
Am J Transl Res. 2024 Dec 15;16(12):7501-7510. doi: 10.62347/SSUF8455. eCollection 2024.
To explore the effects and safety of the flexible vacuum-assisted ureteral access sheath combined with a flexible ureteroscope for the treatment of large renal stones over 3 cm.
In this retrospective study, 122 patients with kidney stones (stone diameter ≥ 3 cm) admitted to our hospital from January 2018 to December 2022 were selected as the study subjects. According to different surgical methods, these patients were divided into an observation group and a control group, with 61 cases in each group. Patients in the control group were treated with the conventional negative pressure-assisted ureteral access sheath combined with flexible ureteroscope, while those in the observation group were treated with the flexible vacuum-assisted ureteral access sheath combined with flexible ureteroscope. The perioperative indexes, stone-free rate, usage rate of basket extraction, inflammation level, renal functional indexes, and incidence of postoperative complications were evaluated and compared between the two groups.
The extubation time, rate of multiple operations, and surgery cost in the observation group were significantly less than those of the control group (all P < 0.05), but the operation time was longer in the observation group than that of the control group (P < 0.05). The stone-free rate at 3 days after surgery in the observation group was higher than that of the control group, while the usage rate of basket extraction of the observation group was significantly less than that of the control group (all P < 0.05). The postoperative levels of C-reactive protein (CRP) and Interleukin (IL)-6 were significantly lower, while the level of IL-10 was significantly higher in the observation group than in the control group (all P < 0.001). The levels of renal functional indexes such as CysC, Scr, and KIM-1 in the observation group were lower than those of the control group (all P < 0.05). The total incidence of postoperative complications in the observation group was 8.20%, which was lower than 24.59% in the control group (P = 0.014). Moreover, postoperative sleep quality was better, and the comfort score was higher in the observation group than that of the control group (all P < 0.001).
The flexible vacuum-assisted ureteral access sheath combined with flexible ureteroscope is effective in the treatment of large renal stones over 3 cm, and may improve the perioperative indexes, postoperative sleep quality and comfort, increase the stone-free rate, alleviate the inflammation levels and kidney functional injury, and reduce the incidence of complications.
探讨可弯曲真空辅助输尿管通路鞘联合可弯曲输尿管镜治疗直径大于3 cm的较大肾结石的疗效及安全性。
本回顾性研究选取2018年1月至2022年12月我院收治的122例肾结石患者（结石直径≥3 cm）作为研究对象。根据手术方式不同，将患者分为观察组和对照组，每组61例。对照组采用传统负压辅助输尿管通路鞘联合可弯曲输尿管镜治疗，观察组采用可弯曲真空辅助输尿管通路鞘联合可弯曲输尿管镜治疗。评估并比较两组患者的围手术期指标、结石清除率、套石篮使用率、炎症水平、肾功能指标及术后并发症发生率。
观察组的拔管时间、再次手术率和手术费用均显著低于对照组（均P<0.05），但观察组的手术时间长于对照组（P<0.05）。观察组术后3天的结石清除率高于对照组，而观察组的套石篮使用率显著低于对照组（均P<0.05）。观察组术后C反应蛋白（CRP）和白细胞介素（IL）-6水平显著低于对照组，而IL-10水平显著高于对照组（均P<0.001）。观察组的胱抑素C（CysC）、血清肌酐（Scr）和肾损伤分子-1（KIM-1）等肾功能指标水平低于对照组（均P<0.05）。观察组术后并发症总发生率为8.20%，低于对照组的24.59%（P=0.014）。此外，观察组术后睡眠质量更好，舒适度评分高于对照组（均P<0.001）。
可弯曲真空辅助输尿管通路鞘联合可弯曲输尿管镜治疗直径大于3 cm的较大肾结石疗效显著，可改善围手术期指标、术后睡眠质量和舒适度，提高结石清除率，减轻炎症水平和肾功能损伤，降低并发症发生率。
