Application of MOSES laser in flexible ureteroscopic lithotripsy for patients with renal calculi
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摘要: 目的 探讨肾结石患者在经尿道输尿管软镜碎石术(FURL)中采用摩西(MOSES)激光的治疗效果。方法 回顾性分析2016年4月—2021年3月在首都医科大学电力教学医院接受经尿道FURL联合普通钬激光治疗的141例肾结石患者，并将其纳入对照组；收集同期医院接受经尿道FURL联合MOSES激光治疗的106例肾结石患者纳入观察组；全部患者术后均完成1年的随访，比较两组患者结石清除成功率、手术时间、尿管留置时间、术后住院时间，比较两组患者术前、术后1个月时肾功能指标(尿酸、肌酐、血钙)，统计两组患者术后并发症情况及术后1年内复发情况。结果 观察组结石清除成功率较对照组高，手术时间、尿管留置时间、术后住院时间较对照组低(P < 0.05)；术后1个月，两组尿酸、肌酐、血钙水平改善，且观察组改善更明显(P < 0.05)；两组术后并发症总发生率比较，差异无统计学意义(P>0.05)；观察组患者术后1年复发率低于对照组，复发时间晚于对照组(P < 0.05)。结论 经尿道FURL使用MOSES激光可提高肾结石患者结石清除成功率，缩短手术、住院时间，改善患者肾脏功能，且术后并发症较少，术后1年复发率较低。
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关键词:
- 肾结石 /
- 经尿道输尿管软镜碎石术 /
- 摩西激光
Abstract: Objective To investigate the therapeutic effect of MOSES laser in flexible ureteroscopic lithotripsy (FURL) for renal calculi.Methods The data of 141 patients with renal calculi who received transurethral FURL combined with ordinary holmium laser from April 2016 to March 2021 in Electric Power Teaching Hospital of Capital Medical University were collected and included in the control group, while the data of 106 patients with renal calculi treated by transurethral FURL combined with MOSES laser in the same period in the hospital were collected and included in the observation group. All patients were followed up for one year after operation. The calculus removal success rate, operation related evaluation indexes (operation time, urinary catheter retention time and postoperative hospitalization time) and renal function indexes (uric acid, creatinine and blood calcium) of patients in both groups were compared before and one month after operation. The postoperative complications and recurrence within one year after operation of patients in both groups were counted.Results The success rate of calculus removal in the observation group was higher than that in the control group (P < 0.05). The operation time, urinary catheter retention time and postoperative hospitalization time of patients in the observation group were shorter than those in the control group (P < 0.05). One month after operation, the levels of uric acid, creatinine and blood calcium in both groups were lower than those before operation, and compared with the control group, the observation group were lower, with statistical significant differences (P < 0.05). There was no statistical significant difference in the total incidence of postoperative complications between the two groups (P>0.05). One year after operation, compared with the control group, the recurrence rate of the observation group was lower, and the recurrence time was later (P < 0.05).Conclusion The use of MOSES laser in transurethral FURL can improve the success rate of calculus removal in patients with renal calculi, shorten the time of operation and hospitalization, improve the renal function of patients, and has fewer postoperative complications and low recurrence rate one year after operation.-
Key words:
- renal calculi /
- flexible ureteroscopic lithotripsy /
- MOSES laser
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表 1 两组患者手术相关评价指标比较
X±S，M(P25，P75) 组别 例数 手术时间/min 尿管留置时间/h 术后住院时间/d 观察组 106 78.25±6.45 42.18±5.64 4.00(3.00，5.00) 对照组 141 89.43±7.94 49.12±6.47 5.00(4.00，6.00) t值 - 12.205 8.804 9.581 P值 - < 0.001 < 0.001 < 0.001 
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表 2 两组肾功能指标比较
X±S 组别 例数 尿酸/(μmol·L-1) 肌酐/(μmol·L-1) 血钙/(mmol·L-1) 术前 术后1个月 术前 术后1个月 术前 术后1个月 观察组 106 368.83±18.25 297.72±14.381) 98.34±5.76 69.56±4.331) 2.55±0.22 2.34±0.151) 对照组 141 371.54±18.65 312.25±15.661) 98.05±5.43 72.18±4.951) 2.51±0.25 2.42±0.191) t值 - 1.141 7.473 0.418 4.337 1.284 3.231 P值 - 0.255 < 0.001 0.677 < 0.001 0.200 0.001 注：与同组术前比较，1)P < 0.05。
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表 3 两组术后并发症比较
例(%) 组别 例数 出血 术后感染 石街形成 合计 观察组 106 2(1.89) 0(0) 1(0.94) 3(2.83) 对照组 141 3(2.13) 1(0.71) 4(2.84) 8(5.67) χ2值 - 0.579 P值 - 0.447
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