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通讯作者:

顾民,E-mail:lancetgu@aliyun.com

中图分类号:R692.4

文献标识码:A

文章编号:1007-4368(2022)07-1001-07

DOI:10.7655/NYDXBNS20220713

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目录contents

    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)]while130 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 were39.23% and 82.94% . Stone ⁃free rates in first month were59.23% 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,which all 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 were70.31% and 90.57%,stone ⁃ free rates in first month were85.94% 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.

  • 泌尿系结石是一种泌尿外科常见病,中国成年人尿石症的患病率为6.5%,而且复发率高,10年复发率达50%[1-2];主要的病因有泌尿系统感染、代谢异常、饮食习惯以及环境等。临床上有上尿路结石与下尿路结石之分,下尿路结石少见且处理方法简单,而上尿路结石较为多见且处理较为复杂,主要分为输尿管结石和肾结石,好发于20~50岁的人群,男性的发生率普遍较高[3]。随着医疗科技的飞速发展,输尿管软镜技术近几年被广泛应用于临床,尤其在上尿路结石方面优势很明显,具有操作简单、视野清晰、安全性以及碎石成功率高等一系列优点[4]。但是单纯一期软镜手术(术前未预留双J管等)会出现更多并发症,如输尿管及肾损伤、术中出血、术后感染、结石清除率低等。间苯三酚为一种非阿托品、非罂粟碱类、具较高亲肌性的平滑肌解痉药物,并且静脉注射药效高、起效快,能在给药的15min左右达到最高血药浓度[5],所以主要用于缓解某些急性痉挛性疼痛,如因胆道功能、泌尿系统或消化系统出现障碍而诱发的疼痛[6-9],临床上,间苯三酚规定用量范围为80~200mg,常配于250mL葡萄糖水中,静脉滴注,每日1次。已有大量的临床研究证明了间苯三酚能解除输尿管的痉挛,改善输尿管状态,并且不良反应少,安全性高,但术前使用间苯三酚对输尿管软镜碎石取石术(retrograde intrarenal surgery,RIRS)会产生怎样的影响研究较少,因此本研究拟探究术前使用不同剂量间苯三酚对RIRS的安全性及有效性。

  • 1 对象和方法

  • 1.1 对象

  • 收集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,纳入标准:①成功实施RIRS手术且均为单侧;②年龄18~70岁,性别不限;③CT或者B超确诊为上尿路结石,并依据中国泌尿外科疾病诊疗指南及欧洲泌尿科学会(EAU)指南推荐,符合RIRS手术指征患者; ④无相关药物过敏史,无严重肝、肾、心脏及造血系统疾病。排除标准:①易过敏体质者;②术前严重感染未纠正患者;③缺少相关临床资料患者;④预留双J管及同侧有过内镜碎石手术史患者。⑤严重泌尿道狭窄,内镜置入困难,无法进行手术患者; ⑥既往有过肾移植或尿路改道手术史者;⑦有泌尿系畸形,如盆腔异位肾、海绵肾、马蹄肾畸形患者及骨骼系统畸形患者。⑧妊娠期及哺乳期妇女;⑨伴有无法控制的高血压、心肌梗死、心律失常等相关严重疾病者;⑩术前12h内使用其他解痉止痛药物治疗患者;11拒绝加入本项研究者。

  • 本研究共收集患者382例,其中符合纳入标准的患者329例;根据是否使用间苯三酚分为治疗组177例,对照组152例;在治疗组中,根据剂量的不同分为普通剂量组(80~120mg)67例和高剂量组 (160~200mg)110例;所有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64例和UAS置入成功高剂量组106例)和UAS置入成功对照组130例;所有UAS置入失败患者均留置双J管1个月,等待二期手术。

  • 本研究经南京医科大学第二附属医院伦理委员会批准(批准号:[2021]⁃KY⁃142⁃01)。并且所有手术及操作均征得患者理解和同意并签署患者知情同意书。

  • 1.2 方法

  • 1.2.1 手术方法

  • 行CT或B超确诊为上尿路结石且有RIRS手术适应证的患者,本院泌尿外科医师根据用药习惯,于术前15min予以80~200mg的间苯三酚静滴,或不予以间苯三酚静滴;予以间苯三酚静滴记为治疗组,不予以间苯三酚静滴记为对照组。

  • 具体手术步骤如下:患者全身麻醉后,摆截石体位,常规消毒铺巾。使用8.0/9.8F输尿管硬镜沿尿道置入膀胱内,在相应输尿管开口处置入巴德亲水超滑导丝,在导丝引导下直视进入输尿管,沿输尿管行径检查其全程直至肾盂输尿管连接处。如有输尿管上段结石,将其推入肾脏内。留置巴德亲水超滑导丝后,退出输尿管硬镜。在导丝引导下缓慢推入输尿管软镜通道鞘(UAS)(男性患者选用F12/14,45cm鞘;女性患者选用F12/14,35cm鞘)至肾盂输尿管连接处,退出输尿管软镜通道鞘内心并收回导丝。组装并检查电子输尿管软镜。持续注水,通过工作鞘缓慢进入肾盂集合系统。按照肾盂 →上盏→中盏→下盏→输尿管顺序依次检查各个部位后定位结石。若为下盏结石可依据手术中肾盏空间大小利用三角网篮移位器将结石主动移至非下盏区域,亦或是原位碎石。置入220 μm钬激光光纤于软镜工作通道内进行碎石。对于较硬结石可选用“高能+低频”模式使结石碎片化,而对于较为疏松质地的结石可采用“低能+高频”模式将结石粉末化以提高手术碎石效率。对于复杂结石患者,若手术操作时间超过90min,则需要尽快结束手术留置双J管后分期手术,以最大限度地减少并发症发生的可能。通过钬激光将结石粉碎至1~4mm结石碎片后,利用套石网篮将残余结石碎片尽可能地取出,以提高结石有效清除率,降低手术并发症发生率。在软镜直视下将输尿管软镜通道鞘与软镜镜体同时退出,退出的同时观察患者输尿管管壁是否并发损伤。最后,在硬镜下留置双J管,留置导尿管,术毕(手术均为同一组副主任医师及以上高年资医师完成)。

  • 1.2.2 观察指标

  • ①输尿管软镜通道鞘(UAS)置入成功率:F12/14输尿管软镜鞘顺利置入输尿管为成功;②术后结石清除率:一期清除率(术后3d左右行腹部平片检查)和1个月清除率(术后1个月左右复查腹部平片);结石清除及排出成功标准:无结石残留或者结石残留直径小于4mm,无临床症状及体征[10-11]; ③手术并发症发生率:术后出现发热、腰痛等症状则记为有;④术后止痛药物使用次数;⑤手术时间; ⑥住院时间;⑦总药物不良反应:出现头晕、恶心、口干、视物模糊、心悸、皮肤潮红、皮疹等症状则记为有;⑧基本信息:年龄、性别、基础疾病(高血压、糖尿病、泌尿道感染)、结石负荷(单发结石以结石最大横径表示,多发结石以最大横径之和表示)、结石CT值、结石位置(分为下盏或非下盏)。

  • 1.3 统计学方法

  • 采用SPSS24.0软件进行统计学分析。计量数据用均数±标准差(x-±s)表示,两组之间比较行t检验;计数资料用百分率表示,两组之间比较行卡方检验或连续校正卡方检验。P< 0.05为差异有统计学意义。

  • 2 结果

  • 对照组与治疗组、普通剂量组与高剂量组在年龄、性别、有无基础疾病、结石CT值、结石负荷、结石位置方面差异均无统计学意义(P> 0.05,表1);对照组和治疗组的UAS置入成功率分别是85.50%、 96.00%,差异有统计学意义(P< 0.05);普通剂量组与高剂量组的UAS置入成功率分别是95.50%、 96.40%,差异无统计学意义(P> 0.05)。

  • UAS置入成功对照组与治疗组以及UAS置入成功普通剂量组与高剂量组在年龄、性别、有无基础疾病、结石CT值、结石负荷、结石位置差异均无统计学意义(P> 0.05,表2)。

  • UAS置入成功对照组和治疗组的一期清除率分别是39.23%、82.94%;1个月清除率分别是59.23%、92.35%;术后止痛药物使用次数分别是 (5.51±1.43)次、(3.70±1.36)次;手术时间分别是 (103.79±39.37)min、(70.14±26.31)min,差异均有统计学意义(P< 0.05),手术并发症发生率及平均住院时间差异无统计学意义(P> 0.05)。UAS置入成功普通剂量组与高剂量组的一期清除率分别是70.31%、90.57%;1个月清除率分别是85.94%、96.23%;术后止痛药物使用次数分别是 (4.13±1.56)次、(3.44±1.17)次;手术时间分别是 (75.78±21.71)min、(66.74±28.29)min;住院时间分别是(4.09±2.47)d、(3.04±1.75)d,差异均有统计学意义(P< 0.05),手术并发症发生率差异无统计学意义(P> 0.05,表3)。

  • 对照组与治疗组的总药物不良反应发生率分别为1.97%和3.95%,差异无统计学意义(P> 0.05),其中对照组恶心呕吐1例,心悸1例,皮肤潮红1例,治疗组头晕2例,恶心呕吐1例,心悸3例,皮疹1例; 普通剂量组与高剂量组的总药物不良反应发生率分别为4.48%和3.64%,差异无统计学意义(P> 0.05),其中普通剂量组头晕2例,心悸1例,高剂量组恶心呕吐1例,心悸2例,皮疹1例。

  • 表1 对照组、治疗组、普通剂量组及高剂量组患者基本信息比较

  • Table1 Comparison of basic information of patients in the control group,treatment group, normal dose group and high dose group

  • 表2 UAS置入成功对照组、治疗组、普通剂量组及高剂量组患者基本信息比较

  • Table2 Comparison of basic information of patients in the control group, treatment group,normal dose group and high dose group with successful UAS placement

  • 表3 UAS置入成功对照组、治疗组、普通剂量组及高剂量组手术情况对比

  • Table3 Comparison of surgery between the control group, treatment group, normal dose group and high dose group with successful UAS placement

  • 3 讨论

  • 据统计,国内外应用RIRS治疗上尿路结石所占的比例呈逐步上升趋势[12];但是RIRS手术也有很多限制因素及手术并发症,为了提高RIRS手术的疗效,改善患者输尿管条件从而提高置鞘成功率、结石清除率及减少手术并发症等是关键要点。通过本研究统计分析可知RIRS术前15min使用间苯三酚能显著提升RIRS手术疗效,且较少发生药物不良反应。

  • 众所周知,RIRS手术的关键在于UAS的置入是否成功,就本文来看,UAS置入成功率越高,手术的疗效越显著。影响UAS置入成功率因素很多,如输尿管条件(是否严重狭窄、迂曲及畸形)、输尿管状态(是否痉挛)、鞘的粗细(临床常用F12/14)等。本研究普通剂量组与高剂量组的UAS置入成功率大于对照组可能是间苯三酚解除了输尿管平滑肌痉挛,从而提高了置鞘成功率。相关文献报道术前留置双J管UAS置入成功率能达到94.00%[13],但是增加了有创操作的风险,存在一定的置管并发症,诸如尿路感染、血尿、膀胱刺激症、肾脏尿液反流、双J管移位、导致化学性间质膀胱炎、输尿管穿孔等[14-17];术前使用其他类型的解痉剂如α受体阻滞剂或M受体阻滞剂UAS置入成功率能达到85.00%[18],联合使用UAS置入成功率是93.00%[13],本研究UAS置入成功率普通剂量组为95.50%,高剂量组为96.40%,说明术前使用间苯三酚能达到术前留置双J管及术前联合使用α受体及M受体阻滞剂类似效果;在结石清除率方面,碎石术后促进排石的原则主要为缓解输尿管痉挛、减轻输尿管水肿、控制上尿路感染等。UAS置入成功的对照组与治疗组其一期清除率有明显差异,可能因为间苯三酚能解除输尿管平滑肌痉挛,使输尿管舒张[6-7],而UAS置入成功对照组术前未使用间苯三酚,因此在UAS置入时,UAS置入成功对照组相较于治疗组更容易导致输尿管壁的损伤出血,这对手术视野有着非常大的影响,干扰碎石取石,并且网篮取石时会反复摩擦输尿管壁,因术前未使用间苯三酚,UAS置入成功对照组会更容易导致输尿管痉挛水肿,影响网篮取石,因此UAS置入成功对照组结石容易残留。UAS的置入会导致术后输尿管壁水肿[19],影响残石的排出,相关研究表明,间苯三酚在治疗产程中宫颈的水肿及痉挛方面有着优秀的表现[20-21],因此猜测间苯三酚能很好地减轻RIRS术后输尿管的水肿,并缓解输尿管的痉挛,促进UAS置入成功治疗组残石的排出。查阅相关文献可知,CT值 (> 800HU)及结石负荷(结石直径> 20mm)会导致RIRS结石清除率降低[22-23];经过分析原始数据,发现UAS置入成功治疗组及对照组CT值> 800HU患者人数所占比例较高,并且还有一部分结石直径>20mm患者,但两组之间的差异无统计学意义; 因此两组一期结石清除率有明显差异可能是因为两组CT值> 800HU患者人数较多且还有一部分结石直径> 20mm患者,这些患者原本碎石难度就很大且结石容易残留,结石清除率会较低,然而UAS置入成功治疗组使用了间苯三酚,术中碎石取石及术后排石条件好,这可能有效减少CT值及结石负荷对结石清除率的影响,而对照组未使用间苯三酚,较差的碎石取石条件会进一步增加结石残留的可能性,如置入UAS时容易导致输尿管壁损伤出血,影响手术视野及碎石取石,并且血凝块容易黏附包裹结石碎块,导致结石不易被发现及清除;再者就是为求视野清晰,术中加强冲洗,导致结石碎块分散于各个肾盏,甚至沉积于下盏,增加了碎石取石难度,容易导致结石遗漏;因此可能导致两组一期结石清除率有所差异。UAS置入成功对照组与治疗组其1个月清除率也有显著差异,可能是UAS置入成功对照组的一期结石清除率过低,结石残留太多;研究表明间苯三酚在治疗胃肠道及子宫等其他平滑肌痉挛时,高剂量较普通剂量起效更快,疗效更好,不良反应无明显差异[24-25],本研究UAS置入成功普通剂量组与高剂量组一期清除率和1个月清除率均有差异,因此猜测可能是因为高剂量解除输尿管痉挛的作用更强。

  • 本研究各组之间总药物不良反应发生率无明显差异且很低,均未出现严重药物不良反应,间接说明了RIRS术前使用间苯三酚安全性高,主要是因为间苯三酚在解除平滑肌痉挛的同时无任何抗胆碱样不良反应发生;而其他类型的解痉药物如胆碱受体阻断药阿托品、山莨菪碱等,既往临床使用常出现抗胆碱样不良反应,如头痛、恶心、呕吐、视物不清、尿潴留、心跳加快等症状[26-28];本研究也未发现药物不良反应发生率随着间苯三酚剂量的增加而提高,推测间苯三酚的剂量可能与药物不良反应的发生无相关关系。

  • 因本研究为单中心回顾性研究,仅证明了术前15min使用间苯三酚对RIRS是安全有效的,没有直接与其他类型解痉药物进行比较,未能直接证明间苯三酚较其他解痉药物有更大的优势;因此,仍需行前瞻性研究,比较间苯三酚与其他类型解痉药物安全性和有效性。

  • 综上,术前静滴间苯三酚对RIRS安全有效,能显著提高UAS置入成功率、一期清除率、1个月清除率,减轻术后疼痛、缩短手术时间,且较少发生药物不良反应。此外,相较普通剂量,高剂量间苯三酚的有效性更高,安全性方面可能与其剂量无明显相关性。

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  • 参考文献

    • [1] 曾国华,麦赞林,夏术阶,等.中国成年人群尿石症患病率横断面调查[J].中华泌尿外科杂志,2015,36(7):528-532

    • [2] ZENG G H,MAI Z L,XIA S J,et al.Prevalence of kidney stones in China:an ultrasonography based cross⁃sectional study[J].BJU Int,2017,120(1):109-116

    • [3] GILLAMS K,JULIEBØ ⁃ JONES P,JULIEBØ S Ø,et al.Gender differences in kidney stone disease(KSD):find⁃ ings from a systematic review[J].Curr Urol Rep,2021,22(10):1-8

    • [4] SERCAN S,UGUR O H,CAGLAR C M,et al.A compari⁃ son of retrograde intrarenal surgery and percutaneous nephrolithotomy for management of renal stones?[J].Urol J,2017,14(1):2949-2954

    • [5] XQ L,RT W,QH W,et al.Determination of phloroglucin⁃ ol by HPLC ⁃ MS/MS and its application to a bioequiva⁃ lence study in healthy volunteers[J].Eur Rev Med Phar⁃ macol Sci,2017,21(8):1990-1998

    • [6] BLANCHARD C,POUCHAIN D,VANDERKAM P,et al.Efficacy of phloroglucinol for treatment of abdominal pain:a systematic review of literature and meta ⁃ analysis of randomised controlled trials versus placebo[J].Eur J Clin Pharmacol,2018,74(5):541-548

    • [7] WU F,CHEN Y,ZHENG C H.Efficacy of phloroglucinol for acceleration of labour:a systematic review and meta ⁃ analysis[J].Arch Gynecol Obstet,2021,304(2):421-428

    • [8] CLARA B,PAUL V,DENIS P,et al.Efficacy of phloro⁃ glucinol for the treatment of pain of gynaecologic or ob⁃ stetrical origin:a systematic review of literature of ran⁃ domised controlled trials[J].Eur J Clin Pharmacol,2020,76(1):1-6

    • [9] JUNG H,KIM H J,CHOI E S,et al.Effectiveness of oral phloroglucinol as a premedication for unsedated esophago⁃ gastroduodenoscopy:a prospective,double⁃blinded,place⁃ bo ⁃ controlled,randomized trial[J].PLoS One,2021,16(8):e255016

    • [10] HONG T Y,MICHAEL W.How significant are clinically insignificant residual fragments following lithotripsy?[J].Curr Opin Urol,2005,15(2):127-131

    • [11] DINCEL N,RESORLU B,UNSAL A,et al.Are small re⁃ sidual stone fragments really insignificant in children?[J].J Pediatr Surg,2013,48(4):840-844

    • [12] GERAGHTY R M,PATRICK J,SOMANI B K.World⁃ wide trends of urinary stone disease treatment over the last two decades:a systematic review[J].J Endourol,2017,31(6):547-556

    • [13] 张庆玲,顾晓箭,徐彦,等.联合应用α受体和M受体阻滞剂提高输尿管软镜手术中输尿管通道鞘置入成功率的效果[J].江苏医药,2016,42(21):2360-2362

    • [14] 王则宇,高小峰.输尿管软镜争议问题的探讨[J].微创泌尿外科杂志,2021,10(1):1-5

    • [15] KARAGÜZEL E,KUTLU Ö,KAZAZ ¡ O,et al.Knotted ureteral stent:a rare complication of ureteral stent usage [J].Urol Res,2012,40(6):793-795

    • [16] BOSIO A,ALESSANDRIA E,DALMASSO E,et al.How bothersome double ⁃ J ureteral stents are after semirigid and flexible ureteroscopy:a prospective single⁃institution observational study[J].World J Urol,2019,37(1):201-207

    • [17] RAMACHANDRA M,MOSAYYEBI A,CARUGO D,et al.Strategies to improve patient outcomes and QOL:cur⁃ rent complications of the design and placements of ureter⁃ ic stents[J].Res Rep Urol,2020,12:303-314

    • [18] 朱超,黄家威.在输尿管软镜碎石治疗中使用α、M受体阻滞剂对输尿管通道建立及术后双J管综合征和疼痛的影响[J].临床外科杂志,2020,28(2):162-164

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    • [20] 何梅,周文红.间苯三酚加速产程进展的效果分析 [J].国际妇产科学杂志,2016,43(1):51-52

    • [21] 徐高侠,周娟,魏霞霞.间苯三酚注射液对产程活跃期宫颈水肿产妇的临床效果分析[J].广西医科大学学报,2016,33(5):873-875

    • [22] 赵德威,倪立董,王大亚,等.输尿管软镜治疗输尿管上段不同CT值结石的临床分析[J].中华腔镜泌尿外科杂志(电子版),2020,14(5):356-359

    • [23] ZHU Z W,YU C,ZENG F,et al.Comparison of retro⁃ grade flexible ureteroscopy and percutaneous nephroli⁃ thotomy in treating intermediate ⁃ size renal stones(2~ 3cm):a meta⁃analysis and systematic review[J].Int Braz J Urol,2019,45(1):10-22

    • [24] 毕春花,史芸,姜靖,等.不同剂量间苯三酚治疗急性胃肠炎腹痛临床研究[J].世界临床医学,2015,9(5):2-9

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