Efficacy of flexible ureteroscopy for the treatment of renal and upper ureteral calculi smaller than 2 cm based on the mode of enhanced recovery after surgery
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摘要: 目的 探讨加速康复外科(ERAS)模式下输尿管软镜碎石(F-URS)治疗直径小于2 cm肾及输尿管上段结石的疗效。 方法 将拟行手术治疗的80例肾及输尿管上段结石(直径小于2 cm)患者按照随机数字表法分为ERAS组与对照组,各40例。2组均行F-URS治疗,对照组采用传统围术期处理, ERAS组采用ERAS外科处理,比较2组围术期相关指标、机体应激反应及术后并发症情况。 结果 与对照组比较, ERAS组首次进食时间、结石排净时间、术后住院时间均显著缩短(P<0.05)。与术前比较, ERAS组和对照组术后1 h白细胞计数(WBC)、C反应蛋白(CRP)差异均有统计学意义(P<0.05); 术后1 h, 2组各应激反应指标均不同程度升高,术后1 d开始下降, ERAS组术后1、3 d各指标均显著低于对照组(P<0.05)。ERAS组术后并发症发生率显著低于对照组(P<0.05)。 结论 ERAS模式下F-URS治疗直径小于2 cm的肾及输尿管上段结石,可缩短患者住院时间,减轻应激反应,降低围术期并发症的发生率。Abstract: Objective To explore the efficacy of flexible ureteroscopy(F-URS)for the treatment of renal and upper ureteral calculi smaller than 2 cm based on the mode of enhanced recovery after surgery(ERAS). Methods A total of 80 patients with renal and ureteral calculi(smaller than 2 cm)who were selected for surgical treatment were randomly divided into ERAS group and the control group according to random number table method. All the patients were given F-URS, the control group(n=40)was given traditional perioperative management, ERAS group(n=40)was given ERAS surgical treatment process. The perioperative relevant indicators, the body's stress response and postoperative complications were comparatively analyzed. Results Compared with the control group, ERAS group had significantly shorter time of first feeding, removal time of calculi and postoperative hospital stay(P<0.05). Compared with operation before, the ERAS group and the control group showed significant differences in leukocyte count(WBC), C reactive protein(CRP )at 1 h after operation(P<0.05). At 1 h after surgery, each stress response index of the two groups increased to different degrees, and then began to decrease at 1st day of surgery(P<0.05). The ERAS group had significantly lower indexes at 1st day and 3rd day after surgery than the control group(P<0.05). The incidence of postoperative complications in ERAS group was significantly lower than that in the control group(P<0.05). Conclusion F-URS for the treatment of renal and upper ureteral calculi smaller than 2 cm based on the mode of ERAS, can shorten the length of hospital stay, reduce stress response and perioperative complications.
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