Effects of preoperative use of phloroglucinol on retrograde intrarenal surgery
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摘要:
目的：比较术前使用不同剂量间苯三酚对输尿管软镜钬激光碎石取石术(retrograde intrarenal surgery，RIRS)的有效性及安全性。方法：本研究共纳入2018年1月—2020年12月在南京医科大学第二附属医院泌尿外科行RIRS手术的患者 329 例，根据术前间苯三酚使用情况分为治疗组177例[普通剂量组(80~120 mg)67例、高剂量组(160~200 mg)110例]和对照组152例，所有输尿管软镜通道鞘(ureteral access sheath，UAS)置入成功患者再根据术前间苯三酚使用情况分为UAS置入成功治疗组170例[UAS置入成功普通剂量组(80~120 mg)64例、UAS置入成功高剂量组(160~200 mg)106例]和UAS置入成功对照组130例。对各组患者的基本信息、输尿管软镜通道鞘置入成功率、术后结石清除率、手术并发症发生率、术后止痛药物使用次数、手术时间、住院时间及总药物不良反应进行统计学分析。结果：治疗组的输尿管软镜通道鞘置入成功率高于对照组 (96.00% vs. 85.50%)，差异有统计学意义(P ＜ 0.05)；UAS置入成功治疗组的一期清除率和1个月清除率也均高于UAS置入成功对照组(82.94% vs.39.23%，92.35% vs. 59.23%)，术后止痛药物使用次数少于 UAS 置入成功对照组[(3.70±1.36)次 vs. (5.51±1.43)次]，手术时间短于UAS置入成功对照组[(70.14±26.31)min vs.(103.79±39.37)min]，差异均有统计学意义(P ＜ 0.05)； 而 UAS 置入成功高剂量组的一期清除率和 1 个月清除率均高于 UAS 置入成功普通剂量组(90.57% vs. 70.31%，96.23% vs. 85.94%)，术后止痛药物使用次数少于UAS置入成功普通剂量组[(3.44±1.17)次vs.(4.13±1.56)次]，手术时间和住院时间短于 UAS 置入成功普通剂量组[(66.74±28.29)min vs.(75.78±21.71)min，(3.04±1.75)d vs.(4.09±2.47)d]，差异有统计学意义 (P ＜ 0.05)。结论：术前静滴间苯三酚对RIRS是安全有效的，能显著提高输尿管软镜通道鞘置入成功率、一期清除率和1个月清除率，且减轻术后疼痛、缩短手术时间。此外，相较普通剂量，高剂量间苯三酚的有效性更高。
Abstract:
Objective：To compare the efficacy and safety of different doses of preoperative phloroglucinol in retrograde intrarenal surgery(RIRS). Methods：A total of 329 patients in this study were divided into two groups based on the preoperative use of different doses of phloroglucinol，177 cases in the treatment group[67 cases in the normal dose group(80~120 mg)and 110 cases in the high dose group(160~200 mg)]and 152 cases in the control group. Furthermore，all patients with successful UAS insertion were divided into two groups based on the preoperative use of different doses of phloroglucinol，170 cases were included into the treatment group [64 cases in the normal dose group(80~120 mg)and 106 cases in the high dose group(160~200 mg)]while 130 cases were included into the control group. The baseline information of patients，the success rate of UAS insertion，the stonE-free rate，complication rate，the frequencies of postoperative analgesic drugs，operation time，hospital stays and total drug side effects were collected and analyzed. Results：The success rate of UAS insertion in control and treatment group was 85.50% and 96.00%，which were significantly different (P ＜ 0.05). In the control group and treatment group of the successful UAS insertion，the first⁃stage stonE-free rates were 39.23% and 82.94% . Stone ⁃free rates in first month were 59.23% and 92.35%，the average frequencies of postoperative analgesic drugs were (5.51±1.43)times and(3.70±1.36)times，the average operative time were(103.79±39.37)minutes and(70.14±26.31)minutes，whichall were significantly different(P ＜ 0.05). In the normal dose group and high dose group of the successful UAS insertion，the first⁃stage stone ⁃ free rates were 70.31% and 90.57%，stone ⁃ free rates in first month were 85.94% and 96.23%，the average frequencies of postoperative analgesic drugs were(4.13±1.56)times and(3.44±1.17)times，the average operative time were(75.78±21.71)minutes and(66.74±28.29)minutes，the average hospital stays were(4.09±2.47)days and(3.04±1.75)days，which were also significantly different(P ＜ 0.05). Conclusion：Preoperative intravenous infusion of phloroglucinol is safe and effective for RIRS，improving the success rate of UAS insertion，the first⁃stage and onE-month stonE-free rate as well as reducing postoperative pain and operative time. In addition，higher doses of phloroglucinol are more effective than normal doses.
