【摘要】 目的 分析输尿管镜下钬激光碎石术（URHL）对复杂性输尿管结石合并肾盂积水患者应激反应及肾功能的影响。方法 纳入2022年2月至2024年2月张家口市第一医院收治的复杂性输尿管结石合并肾盂积水患者103例进行回顾性研究，根据手术方案的不同将其分为接受输尿管气压弹道碎石术（URSL）治疗的URSL组（54例）和接受URHL治疗的URHL组（49例）。两组均随访1个月。比较两组患者的围术期指标，术前、术后1 d应激反应，术前、术后1个月肾功能、肾盂积水分级，术后1个月并发症发生情况。结果 URHL组手术时间、住院时间更短，结石完全清除率更高，差异有统计学意义（P<0.05）。与术前比较，术后1 d两组血清促肾上腺皮质激素（ACTH）、去甲肾上腺素（NE）、皮质醇（COR）水平升高，但URHL组更低，差异有统计学意义（P<0.05）。术后1个月，两组肌酐（Scr）、尿素氮（BUN）、尿肾损伤分子-1(KIM-1)、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平降低，且URHL组更低，差异有统计学意义（P<0.05）。与术前比较，术后1个月两组肾盂积水分级改善，且URHL组优于URSL组，差异有统计学意义（P<0.05）。术后1个月，URHL组并发症发生率[6.12%(3/49)]低于URSL组[20.37%(11/54)]，差异有统计学意义（P<0.05）。结论 与URSL比较，URHL可降低复杂性输尿管结石合并肾盂积水患者的应激反应，改善围术期指标，提高肾功能，调节肾盂积水分级，并降低并发症发生风险。更多还原

【Abstract】 Objective To analyze the effect of ureteroscopic holmium laser lithotripsy(URHL) on stress response and renal function in patients with complex ureteral calculi complicated with hydronephrosis. Methods A retrospective study was conducted on 103 patients with complex ureteral calculi complicated with hydronephrosis admitted to Zhangjiakou First Hospital from February 2022 to February 2024. According to different surgical protocols, the patients were divided into the URSL group(54 cases) treated with ureteroscopic pneumatic lithotripsy(URSL) and the URHL group(49 cases) treated with URHL. Both groups were followed up for 1 month. Perioperative indicators, stress response at 1 day before and after surgery, renal function and hydronephrosis grading at 1 month before and after surgery, and the incidence of complications at 1 month after surgery were compared between the two groups. Results The URHL group had shorter operation time, shorter hospital stay, and higher complete stone clearance rate, with statistically significant differences(P<0.05). Compared with before surgery, the serum levels of adrenocorticotropic hormone(ACTH), norepinephrine(NE), and cortisol(COR) in both groups increased at 1 day after surgery, but those in the URHL group were lower, with statistically significant differences(P<0.05). At 1 month after surgery, the levels of serum creatinine(Scr), blood urea nitrogen(BUN), urinary kidney injury molecule-1(KIM-1), and neutrophil gelatinase-associated lipocalin(NGAL) in both groups decreased, and those in the URHL group were lower, with statistically significant differences(P<0.05). Compared with before surgery, the hydronephrosis grading of both groups improved at 1 month after surgery, and the URHL group was superior to the URSL group, with a statistically significant difference(P<0.05). At 1 month after surgery, the incidence of complications in the URHL group [6.12%(3/49)] was lower than that in the URSL group [20.37%(11/54)], with a statistically significant difference(P<0.05). Conclusion Compared with URSL, URHL can reduce the stress response of patients with complex ureteral calculi complicated with hydronephrosis, improve perioperative indicators, enhance renal function, regulate hydronephrosis grading, and reduce the risk of complications.更多还原