[1]高　为,张启旺,柯磊磊,等.经尿道输尿管镜碎石术与微创经皮肾镜取石术治疗嵌顿性输尿管上段结石疗效比较[J].新乡医学院学报,2022,39(5):465-469.[doi:10.7683/xxyxyxb.2022.05.013]
　GAO Wei,ZHANG Qiwang,KE Leilei,et al.Comparison of curative effect between transurethral ureteroscopic lithotripsy and minimally invasive percutaneous nephrolithotomy for incarcerated upper ureteral calculi[J].Journal of Xinxiang Medical University,2022,39(5):465-469.[doi:10.7683/xxyxyxb.2022.05.013]
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经尿道输尿管镜碎石术与微创经皮肾镜取石术治疗嵌顿性输尿管上段结石疗效比较
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
39
期数:
2022年5
页码:
465-469
栏目:
临床研究
出版日期:
2022-05-05

文章信息/Info

Title:
Comparison of curative effect between transurethral ureteroscopic lithotripsy and minimally invasive percutaneous nephrolithotomy for incarcerated upper ureteral calculi
作者:
高　为; 张启旺; 柯磊磊; 疏仁义
（池州市人民医院泌尿外科，安徽　池州　247000）
Author(s):
GAO Wei; ZHANG Qiwang; KE Leilei; SHU Renyi
(Department of Urology,the People′s Hospital of Chizhou,Chizhou 247000,Anhui Province,China)
关键词:
嵌顿性输尿管上段结石; 经尿道输尿管镜碎石术; 微创经皮肾镜取石术; 降钙素原; 白细胞介素-6; 丙二醛; 超氧化物歧化酶
Keywords:
incarcerated upper ureteral calculi; transurethral ureteroscopic lithotripsy; minimally invasive percutaneous nephrolithotomy; procalcitonin; interleukin-6; malondialdehyde; superoxide dismutase
分类号:
R693+.4
DOI:
10.7683/xxyxyxb.2022.05.013
文献标志码:
A
摘要:
目的　比较经尿道输尿管镜碎石术（URL）与微创经皮肾镜取石术（MPCNL）治疗嵌顿性输尿管上段结石的临床效果。方法　选择2018年3月至2020年12月池州市人民医院收治的64例嵌顿性输尿管上段结石患者为研究对象，根据治疗方法将患者分为URL组（30例）和MPCNL组（34例）。比较2组患者的手术时间、术中出血量、住院时间、结石清除率及并发症；分别于术前及术后第1、5天检测2组患者血清炎症因子降钙素原（PCT）、白细胞介素-6（IL-6）和应激反应指标丙二醛（MDA）、超氧化物歧化酶（SOD）水平，并进行比较。结果　URL组患者的手术时间显著短于MPCNL组，术中出血量显著少于MPCNL组（P<0.05），2组患者的住院时间比较差异无统计学意义（P>0.05）。URL组和MPCNL组患者的结石清除率分别为66.67%（20/30）、88.24%（30/34），URL组患者的结石清除率显著低于MPCNL组（χ2=4.338，P<0.05）。2组患者术前血清PCT和IL-6水平比较差异无统计学意义（P>0.05）。2组患者术后第1天血清PCT和IL-6水平显著高于术前，术后第5天血清PCT和IL-6水平显著低于术后第1天（P<0.05）；MPCNL组患者术后第5天血清PCT和IL-6水平显著高于术前（P<0.05），URL组患者术后第5天与术前血清PCT和IL-6水平比较差异无统计学意义（P>0.05）。术后第1、5天，URL组患者血清PCT和IL-6水平显著低于MPCNL组（P<0.05）。2组患者术前血清MDA、SOD水平比较差异无统计学意义（P>0.05）。与术前比较，2组患者术后第1天血清MDA水平显著升高，血清SOD水平显著降低（P<0.05）；与术后第1天比较，2组患者术后第5天血清MDA水平显著降低，血清SOD水平显著升高（P<0.05）；2组患者术后第5天血清MDA水平显著高于术前，血清SOD水平显著低于术前（P<0.05）。术后第1、5天，URL组患者血清MDA水平显著低于MPCNL组，血清SOD水平显著高于MPCNL组（P<0.05）。URL组和MPCNL组患者并发症发生率分别为10.00%（3/30）、11.76%（4/34），2组患者并发症发生率比较差异无统计学意义（χ2=0.051，P>0.05）。结论　MPCNL治疗嵌顿性输尿管上段结石的碎石效果优于URL，但URL手术时间短、术中出血量少、患者炎症反应和应激反应较弱，有利于患者术后恢复；临床应根据患者的实际情况来选择适合的治疗方法。
Abstract:
Objective　To compare the curative effect between transurethral ureteroscopic lithotripsy (URL) and minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of incarcerated upper ureteral calculi.Methods　A total of 64 patients with incarcerated upper ureteral calculi admitted to the People′s Hospital of Chizhou from March 2018 to December 2020 were selected as the research subjects,and the patients were divided into URL group (n=30) and MPCNL group (n=34) according to the treatment method.The operation time,intraoperative bleeding,hospitalization time,stone clearance rate and complications were compared between the two groups.The levels of serum inflammatory factors procalcitonin (PCT),interleukin-6 (IL-6) and stress response indexes malondialdehyde (MDA),superoxide dismutase (SOD) were detected and compared before operation and on the first and fifth day after operation,respectively.Results　The operation time of patients in the URL group was significantly shorter than that in the MPCNL group,and the intraoperative bleeding was significantly less than that in the MPCNL group (P<0.05).There was no significant difference in hospitalization time between the two groups (P>0.05).The stone clearance rate of patients in the URL group and MPCNL group was 66.67% (20/30) and 88.24% (30/34),respectively.The stone clearance rate of patients in the URL group was significantly lower than that in the MPCNL group (χ2=4.338,P<0.05).There was no significant difference in the levels of serum PCT and IL-6 between the two groups before operation (P>0.05).The levels of serum PCT and IL-6 on the first day after operation were significantly higher than those before operation,and the levels of serum PCT and IL-6 on the fifth day after operation were significantly lower than those on the first day after operation in the two groups(P<0.05).The levels of serum PCT and IL-6 on the fifth day after operation were significantly higher than those before operation in the MPCNL group (P<0.05).There was no significant difference in the levels of serum PCT and IL-6 between the fifth day after operation and before operation in URL group (P>0.05).The levels of serum PCT and IL-6 in the URL group were significantly lower than those in the MPCNL group on the first and fifth day after operation (P<0.05).There was no significant difference in the levels of serum MDA and SOD between the two groups before operation (P>0.05).Compared with before operation,the serum MDA level was significantly increased and the serum SOD level was significantly decreased in the two groups on the first day after operation (P<0.05).Compared with the first day after operation,the serum MDA level was significantly decreased and the serum SOD level was significantly increased in the two groups on the fifth day after operation in the two groups (P<0.05).On the fifth day after operation,the serum MDA level was significantly higher than that before operation,and the serum SOD level was significantly lower than that before operation in the two groups (P<0.05).On the first and fifth day after operation,the serum MDA level in the URL group was significantly lower than that in the MPCNL group,and the serum SOD level in the URL group was significantly higher than that in the MPCNL group (P<0.05).The incidence of complications in the URL group and MPCNL group was 10.00% (3/30) and 11.76% (4/34),respectively.There was no significant difference in the incidence of complications between the two groups (χ2=0.051,P>0.05).Conclusion　The lithotripsy effect of MPCNL in the treatment of incarcerated upper ureteral calculi is better than that of URL,but the URL has shorter operation time,less intraoperative bleeding,and weaker inflammatory response and stress response,which is beneficial to patients′ postoperative recovery.The actual situation to choose the appropriate treatment method.The appropriate treatment method should be selected according to the actual situation of the patient.

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更新日期/Last Update: 2022-05-05