微创泌尿外科杂志

目的：观察头端可弯曲输尿管负压吸引鞘联合输尿管软镜治疗上尿路结石术后无管化有效性与安全性。方法：回顾性分析2021年1月至2023年1月我院收治的70例上尿路结石患者，均行头端可弯曲输尿管负压吸引鞘联合输尿管软镜治疗，依据术后是否常规留置双J管分为研究组(n=36)，术后无管化，对照组(n=34)，术后常规置管。比较两组的结石清除率、疼痛程度、炎症指标、应激指标、术后并发症发生情况。结果：研究组术后24h结石清除率97.22%(35/36)与对照组94.12%(32/34)相较，差异无统计学意义(连续校正χ²=0.003,P=0.960)。术后24h、48h、72h，研究组的视觉模拟评分法(VAS)评分均低于对照组(P<0.05)。术后24h，两组的C反应蛋白(CRP)、白细胞介素-6(IL-6)、降钙素原(PCT)、去甲肾上腺素(NE)、皮质醇均高于术前(P<0.05)，且研究组低于对照组(P<0.05)。研究组术后并发症总发生率(22.22%,8/36)低于对照组(67.65%,23/34)(P<0.05)。结论：头端可弯曲输尿管负压吸引鞘联合输尿管软镜治疗上尿路结石术后无管化是可行的，并不影响结石清除率，且能减轻术后疼痛，有更低的炎症反应、应激反应、术后并发症发生率。

Objective: To observe the effectiveness and safety of no indwelling double J stent after upper urinary tract stone surgery by using a head flexible ureteral negative pressure suction sheath combined with ureteroscope.Methods: A retrospective analysis was performed on 70 patients with upper urinary tract calculi admitted to our hospital from January 2021 to January 2023. All patients were treated with flexible ureteroscopy combined with flexible ureteroscope. According to whether the double J tube was routinely indwelling after surgery, they were divided into study group(n=36), no tube after surgery, and control group(n=34), routine catheterization after surgery. The stone clearance rate, pain level, inflammation indicators, stress indicators, and postoperative complications were compared between the two groups. Results: The stone removal rate in the study group 97.22%(35/36) was not statistically obviously different from 94.12%(32/34) in the control group(continuous correction χ²=0.003,P=0.960).At 24 h, 48 h, and 72 h after surgery, the visual analogue scale(VAS) score in the study group was lower than that in the control group(P<0.05). At 24h after surgery, the levels of C-reactive protein(CRP), interleukin-6(IL-6), procalcitonin(PCT), norepinephrine(NE), and cortisol in both groups were higher than those before surgery(P<0.05), and the levels in the study group were lower than those in the control group(P<0.05). The total incidence of postoperative complications in the study group(22.22%,8/36) was lower than that in the control group(67.65%, 23/34;P<0.05). Conclusion: It is feasible to treat tubeless upper urinary calculi with flexible ureteroscope combined with flexible ureteroscope, which does not affect the stone removal rate, and can alleviate postoperative pain, with a lower incidence of inflammatory reactions, stress reactions, and postoperative complications.