输尿管硬镜联合勺状阻石篮激光碎石术治疗输尿管1.5 cm及以上结石的效果

doi:10.19723/j.issn.1671-167X.2025.04.008

摘要/Abstract

摘要：

目的: 探讨输尿管硬镜联合勺状阻石篮激光碎石术(rigid ureteroscopic laser lithotripsy combined with N-trap, RULL + N-trap) 治疗最大径≥1.5 cm输尿管结石的效果及安全性。方法: 采用队列研究的方法, 纳入北京大学第三医院泌尿外科同一医疗组于2021年6月至2024年9月完成的364例采用RULL + N-trap治疗的输尿管结石患者, 排除21例结局变量缺失的患者, 形成38例最大径≥ 1.5 cm输尿管结石患者队列和305例最大径 < 1.5 cm输尿管结石患者队列。随后采用倾向性评分匹配(propensity score matching, PSM)算法, 筛选出31例最大径≥ 1.5 cm输尿管结石患者以及与之基线相平衡的31例最大径 < 1.5 cm输尿管结石患者, 分析两组间清石率、手术时间、术后住院时长等差异有无统计学意义。结果: 在接受RULL + N-trap的31例最大径≥1.5 cm输尿管结石患者中, 对比最大径 < 1.5 cm输尿管结石患者, 手术时长为(85.8 ± 28.8) min vs.(62.4 ± 24.6) min, P < 0.05;术后住院日情况为(2.26 ± 1.79) d vs.(2.03 ± 0.80) d, P >0.05;术后第1天清石率分别为90.3% vs. 100.0%, P >0.05, 术后1个月的清石率分别为93.5% vs. 100.0%, P >0.05;术后肌酐(serum creatinine, SCr)变化情况为(-6.58 ± 16.10) μmol/L vs.(-13.70 ± 12.50) μmol/L, P >0.05;术后肾小球滤过率(glomerular filtration rate, GFR)变化情况为(5.92 ± 14.90) mL/(min·1.73 m²) vs.(7.47 ± 11.20) mL/(min·1.73 m²), P>0.05。结论: RULL + N-trap是治疗最大径≥1.5 cm输尿管结石的有效方法, 与 < 1.5 cm的输尿管结石相比, 总体治疗效果相似, 值得推广。

关键词: 输尿管硬镜, 勺状阻石篮, 输尿管结石

Abstract:

Objective: To investigate the efficacy of rigid ureteroscopic laser lithotripsy combined with N-trap (RULL + N-trap), which is scoop-shaped, in the treatment of ureteral stones with a maximum diameter ≥ 1.5 cm. Methods: This retrospective cohort study included patients diagnosed with ureteral calculi who underwent rigid ureteroscopic lithotripsy (RULL) combined with N-Trap stone entrapment system at the Department of Urology, Peking University Third Hospital, by the same surgical team between June 2021 and September 2024. A total of 364 patients were initially enrolled. After excluding 21 patients due to missing critical outcome variables, two distinct cohorts were established: 38 patients with ureteral stones measuring ≥1.5 cm in maximum diameter, and 305 patients with stones < 1.5 cm in maximum diameter. To minimize selection bias and control for confounding variables, propensity score matching (PSM) was employed. This resulted in two well-balanced groups: 31 patients with stones ≥1.5 cm in maximum diameter and 31 patients with stones < 1.5 cm in maximum diameter, matched on baseline demographic and clinical characteristics. The primary outcomes assessed between the two groups included stone clearance. Secondary outcomes included changes in renal function indicators, specifically serum creatinine (SCr) and estimated glomerular filtration rate (GFR), and other factors like postoperative hospital stay and operative time. Results: In the matched cohort, the patients with stones ≥1.5 cm in maximum diameter had significantly longer operative time compared with those with smaller stones: (85.8±28.8) min vs. (62.4±24.6) min (P < 0.05). Postoperative length of hospital stay showed no significant difference: (2.26±1.79) d vs. (2.03 ± 0.80) d (P>0.05). The stone clearance on postoperative day one was 90.3% in the study group vs. 100.0% in the control group (P>0.05). One month postoperatively, the stone clearance was 93.5% vs. 100.0%, respectively (P>0.05). Changes in SCr were (-6.58±16.10) μmol/L vs. (-13.70±12.50) μmol/L, and changes in GFR were (5.92±14.90) mL/(min·1.73 m²) vs. (7.47±11.20) mL/(min·1.73 m²), with no statistically significant differences observed between the two groups for either renal function marker (P > 0.05). Conclusion: Ureteroscopic lithotripsy combined with N-trap is an optional method for treating ureteral stones with a maximum diameter ≥1.5 cm. The overall therapeutic efficacy is comparable, with the added benefit of significantly reducing the economic burden on patients.

Key words: Rigid ureteroscopic laser lithotripsy, N-trap, Urolithiasis

中图分类号:

R693.4

冀竞辉, 林秀石, 潘大猛, 吴芝莹, 薛子璇, 田晓军, 张树栋, 王滨帅, 邱敏. 输尿管硬镜联合勺状阻石篮激光碎石术治疗输尿管1.5 cm及以上结石的效果[J]. 北京大学学报（医学版）, 2025, 57(4): 676-683.

Jinghui JI, Xiushi LIN, Dameng PAN, Zhiying WU, Zixuan XUE, Xiaojun TIAN, Shudong ZHANG, Binshuai WANG, Min QIU. Efficacy of rigid ureteroscopic laser lithotripsy combined with N-trap in the treatment of ureteral stones with a maximum diameter equal to or greater than 1.5 cm[J]. Journal of Peking University (Health Sciences), 2025, 57(4): 676-683.

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参考文献 18

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Items	Urolithiasis patients with largest diameter ≥ 1.5 cm (n=38)	Urolithiasis patients with largest diameter < 1.5 cm (n=305)	P value
Age/years, M (Min, Max)	48.0 (19.0, 73.0)	48.0 (21.0, 78.0)	0.659
Gender, n(%)			0.398
Male	7 (18.4)	80 (26.2)
Female	31 (81.6)	225 (73.8)
BMI/(kg/m²), M (Min, Max)	24.8 (17.9, 32.7)	25.6 (17.4, 38.8)^b	0.331
Preoperative SCr/(μmol/L), M (Min, Max)	97.5 (70.0, 190.0)	85.0 (47.0, 237.0)	0.001
Preoperative GFR /[mL/(min·1.73 m²)], M (Min, Max)	87.0 (44.0, 114.0)	94.9 (31.0, 143.0)	0.020
Distance/mm^a, M (Min, Max)	17.5 (0.0, 181.0)	59.0 (0.0, 244.0)^c	< 0.001
CT value of stones/HU, M (Min, Max)	1 120 (424, 1 660)	800 (116, 1 780)^c	< 0.001

Variables	B	Standard error	Wald	df	P value	Exp(B)	95% CI for Exp(B)
Gender	0.305	0.400	0.761	1	0.446	1.356	0.574 - 3.215
Age	-0.014	0.016	0.922	1	0.357	0.986	0.957 - 1.017
Preoperative SCr	-0.014	0.009	1.481	1	0.139	0.987	0.969 - 1.005
Preoperative GFR	-0.013	0.014	0.898	1	0.369	0.987	0.960 - 1.015
Diameter of stone	-0.004	0.036	0.118	1	0.906	0.996	0.931 - 1.066
CT value of stones	-0.001	0.001	1.837	1	0.066	0.999	0.999 - 1.000
Constant	5.421	2.523	2.149	1	0.032	224.801

Variables	B	Standard error	Wald	df	P value	Exp(B)	95% CI for Exp(B)
Gender	0.514	0.393	1.313	1	0.189	1.671	0.758 - 3.672
Age	-0.029	0.016	1.847	1	0.065	0.971	0.936 - 1.008
Preoperative SCr	-0.019	0.009	5.493	1	0.032	0.981	0.963 - 0.999
Preoperative GFR	-0.025	0.014	3.031	1	0.081	0.976	0.948 - 1.004
Diameter of Stone	-0.003	0.004	0.066	1	0.947	0.998	0.992 - 1.005
CT value of stones	0.000	0.000	0.002	1	0.958	1.000	0.999 - 1.000
Constant	6.837	2.504	2.730	1	0.006	9.307

Items	Urolithiasis patients with largest diameter ≥ 1.5 cm (n=31)	Urolithiasis patients with largest diameter < 1.5 cm (n=31)	P value
Age/years, M (Min, Max)	47.0 (19.0, 73.0)	38.0 (22.0, 72.0)	0.292
Gender, n(%)			1.000
Male	26 (83.9)	26 (83.9)
Female	5 (16.1)	5 (16.1)
BMI/(kg/m²), ${\bar x}$±s	25.00 ± 2.64	24.70 ± 2.59	0.688
Preoperative SCr/(μmol/L), M (Min, Max)	91.0 (70.0, 158.0)	93.0 (53.0, 156.0)	0.844
Preoperative GFR /[mL/(min·1.73 m²)], M (Min, Max)	88.3 (44.0, 114.0)	97.3 (40.0, 143.0)	0.130
Distance/mm^a, M (Min, Max)	17 (0, 181)	25.0 (0, 189)	0.773
CT value of stones/HU, ${\bar x}$±s	1 140 ± 330	910 ± 291	0.005

Items	Urolithiasis patients with largest diameter ≥ 1.5 cm not matched (n=7)	Urolithiasis patients with largest diameter ≥ 1.5 cm matched (n=31)	P value
Age/years, ${\bar x}$±s	50.3 ± 13.7	48.8 ± 13.6	0.706
Gender, n(%)			0.820
Male	2 (28.6)	26 (83.9)
Female	5 (71.4)	5 (16.1)
BMI/(kg/m²), ${\bar x}$±s	24.90 ± 2.88	25.00 ± 2.64	0.825
Preoperative SCr/(μmol/L), M (Min, Max)	116.0 (74.0, 190.0)	91.0 (70.0, 158.0)	0.057
Preoperative GFR/[mL/(min·1.73 m²)], ${\bar x}$±s	81.3 ± 11.1	86.2 ± 19.6	0.228
Distance/mm^a, M (Min, Max)	18.0 (0.0, 57.8)	17.0 (0.0, 181.0)	0.865
CT value of stones/HU, ${\bar x}$±s	850 ± 371	1 140 ± 330	0.060