2026 年第 8 期 第 21 卷

输尿管软镜碎石术取石联合超脉冲铥激光肾盏颈切开术治疗肾盏憩室结石的临床效果

Clinical efficacy of flexible ureteroscopic lithotripsy combined with super-pulsed thulium laser calyceal neck incision for calyceal diverticular calculi

作者：卢云汉牛颜良董秋华薛强高艳王赫

英文作者：Lu Yunhan Niu Yanliang Dong Qiuhua Xue Qiang Gao Yan Wang He

单位：哈尔滨工业大学附属哈尔滨市第一医院泌尿外科，哈尔滨150000

英文单位：Department of Urology The First Hospital of Harbin Harbin Institute of Technology， Harbin 150000 China

关键词：肾盏憩室结石；输尿管软镜碎石术；经皮肾镜碎石术；铥激光；可弯曲负压吸引鞘；肾盏颈切开术；憩室黏膜烧灼术

英文关键词：Calycealdiverticularcalculi;Flexibleureteroscopiclithotripsy;Percutaneousnephrolithotomy; Thuliumlaser;Flexiblenegative-pressuresuctionsheath;Calycealneckincision;Diverticularmucosalcauterization

• 摘要：

• 目的 探讨输尿管软镜碎石取石联合超脉冲铥激光肾盏颈切开术治疗肾盏憩室结石的临床效果。方法 前瞻性选取2023年1月至2024年12月于哈尔滨工业大学附属哈尔滨市第一医院及县区级医院行手术治疗的58例肾盏憩室结石患者作为研究对象。采用随机数字表法将患者分为输尿管软镜碎石术（FURL）组和经皮肾镜碎石术（PCNL）组，各29例。FURL组采用FURL取石联合超脉冲铥激光肾盏颈切开术，PCNL组采用PCNL联合钬激光碎石取石。比较2组患者术前一般资料、手术时间、术后血红蛋白变化、围手术期肾功能指标、结石清除率、住院时间、术后疼痛程度、并发症发生率、肾盏憩室缩小率及患者满意度。结果 2组患者术前一般资料比较差异均无统计学意义（均P>0.05）。FURL组术后血红蛋白下降值、术后疼痛评分、术后住院时间均显著低于/短于PCNL组，憩室缩小率显著高于PCNL组，差异均有统计学意义（均P<0.05）。术后7 d，2组血肌酐、血尿素氮水平均高于术前1 d，但FURL组显著低于PCNL组，差异均有统计学意义（P<0.05）。FURL组满意率显著高于PCNL组［96.6%（28/29）比79.3%（23/29）］（χ2=4.061，P=0.044）。结论 FURL取石联合超脉冲铥激光肾盏颈切开术治疗肾盏憩室结石安全、有效，具有出血少、创伤小、术后恢复快、痛苦小、满意度高等优点。

• Objective To explore the clinical efficacy of flexible ureteroscopic lithotripsy combined with super-pulsed thulium laser calyceal neck incision in the treatment of calyceal diverticular calculi. Methods A total of 58 patients with calyceal diverticular calculi who received surgical treatment in The First Hospital of Harbin, Harbin Institute of Technology and county-level hospitals from January 2023 to December 2024 were prospectively enrolled. Patients were divided into the flexible ureteroscopic lithotripsy (FURL) group and percutaneous nephrolithotomy (PCNL) group via the random number table method, with 29 cases in each group. The FURL group underwent FURL combined with super-pulsed thulium laser calyceal neck incision, while the PCNL group received PCNL combined with holmium laser lithotripsy. Preoperative general data, operation time, postoperative hemoglobin changes, perioperative renal function indicators, stone clearance rate, length of hospital stay, postoperative pain severity, incidence of complications, shrinkage rate of calyceal diverticulum and patient satisfaction were compared between the two groups. Results There were no statistically significant differences in preoperative general data between the two groups (all P>0.05). The postoperative hemoglobin decline value, postoperative pain score and postoperative hospital stay in the FURL group were significantly lower/shorter than those in the PCNL group, while the diverticulum shrinkage rate was markedly higher in the FURL group (all P<0.05). At postoperative day 7, serum creatinine and blood urea nitrogen levels in both groups were higher than preoperative values, but in the FURL group was significantly lower than those in the PCNL group (all P<0.05). The satisfaction rate of the FURL group was obviously higher than that of the PCNL group ［96.6%(28/29) vs 79.3%(23/29)］(χ2=4.061, P=0.044). Conclusion FURL combined with super-pulsed thulium laser calyceal neck incision is safe and effective for treating calyceal diverticular calculi, with the advantages of less bleeding, minimal trauma, rapid postoperative recovery, mild pain and high patient satisfaction.