输尿管软镜和经皮肾镜取石术对老年嵌顿性输尿管上段结石患者围术期炎性因子的影响

Effect of flexible ureteroscope and percutaneous nephrolithotomy on inflammatory factors in elderly patients with impacted upper ureteral calculi during perioperative period

目的探讨输尿管软镜和经皮肾镜取石术(PCNL)对老年嵌顿性输尿管上段结石患者围术期炎性因子的影响。方法选取72例老年嵌顿性输尿管上段结石患者,根据手术方式分为输尿管软镜组("一步法"输尿管软镜取石术,n=39)和PCNL组(PCNL术,n=33)。比较两组围术期资料,并在术前1 d、术后第1天和第3天检测并比较两组血干扰素(IFN)-γ、白细胞介素(IL)-12等辅助性T细胞(Th)1细胞因子及IL-4、IL-10、IL-6等Th2细胞因子水平。结果输尿管软镜组的结石位于L3以下的比例显著高于PCNL组(P<0.05),手术时间显著低于PCNL组(P<0.05),两组术后有无行体外冲击波碎石术辅助排石、有无出现输尿管穿孔或继发狭窄、术后发热发生率、术后平均住院时间、术后2 w内的结石清除率等其他术中术后资料比较差异均无统计学意义(P>0.05)。两组术后第1、3天IFN-γ、IL-12水平显著低于术前,而IL-4、IL-10、IL-6水平均显著高于术前(P<0.05)。术后第1、3天,输尿管软镜组IFN-γ、IL-12水平均显著高于PCNL组,而IL-4、IL-10、IL-6水平均显著低于PCNL组(P<0.05)。结论输尿管软镜和PCNL都是嵌顿性输尿管上段结石安全、有效的治疗方法,与PCNL相比,输尿管软镜术后Th1/Th2处于相对平衡状态,炎性因子的变化较小,可能与其创伤小、手术时间短、出血少等有关。

Objective To investigate the effect of flexible ureteroscope and percutaneous nephrolithotomy（PCNL） on inflammatory factors in elderly patients with impacted upper ureteral calculi during perioperative period.Methods 72 elderly patients with impacted upper ureteral calculi were enrolled for the study and divided into flexible ureteroscope（ n = 39） and PCNL groups（ PCNL,n = 33） according to the operation method. Perioperative data were compared between two groups. data,and the levels of blood Th1 cytokines including interferon（IFN）-γand interleukin（IL）-12,and Th2 cytokines including IL-4,IL-10,IL-6 were detected and compared between two groups at 1 d before treatment,1 d and 3 d after treatment.Results（ 1） The rate of stones located below L3 in flexible ureteroscope group was significantly higher than that in PCNL group（ P〈0.05）. There were no significant differences in age,gender,body mass index,lateral aspect of affected kidney,degree of hydronephrosis,the location and maximum diameter of stones between two groups（ P 0. 05）.（ 2） The operation time in flexible ureteroscope group was significantly lower than that in PCNL group（ P〈0.05）. There were no significant differences in rate of extracorporeal shock wave lithotripsy auxiliary,ureteral perforation or secondary stenosis,postoperative fever,average postoperative hospital stay,stone clearance rate within 2 weeks between two groups（ P〈0.05）.（ 3） The levels of IFN-γand IL-12 at 1 d,3 d after operation in two groups were significantly lower than those before operation,while the levels of IL-4,IL-10 and IL-6 were significantly higher than those before operation（ P〈0.05）. There were no significant differences in levels of IFN-γ,IL-12,IL-4,IL-10 and IL-6 before operation between two groups（P〈0.05）. The levels of IFN-γand IL-12 at 1 d,3 d after operation in flexible ureteroscope group were significantly higher than those in PCNL group,while the levels of IL-4,IL-10 and IL-6 were significantly lower than those in PCNL group（ P〈0.05）.Conclusions Flexible ureteroscopy and PCNL are safe and effective treatment for impacted upper ureteral calculi. Compared with PCNL,Th2/Th2 after operation is in relatively balanced state for flexible ureteroscopy operation,and its changes of inflammatory factors are less during perioperative period,which might be associated with less trauma,shorter operative time,less bleeding and so on.