输尿管软镜碎石术与经皮肾镜碎石术治疗肾结石的临床效果及对患者炎症反应、应激反应的影响

Clinical Efficacy of Flexible Ureteroscopic Lithotripsy and Percutaneous Nephrolithotripsy in the Treatment of Patients with Renal Calculi and the Effect on the Inflammatory Response and Stress Response

目的:探讨输尿管软镜碎石术与经皮肾镜碎石术治疗肾结石的临床效果及对患者炎症反应与应激反应的影响。方法:收集2018年1月至2019年5月我院收治的96例肾结石患者作为研究对象,依据治疗方式分为观察组与对照组,每组48例。观察组患者采用输尿管软镜取石术,对照组采用经皮肾镜碎石术,比较两组患者的手术相关指标、并发症的发生情况、治疗前后血清白介素-6(IL-6)、C反应蛋白(CRP)、皮质醇(Cor)、促肾上腺皮质激素(ACTH)及去甲肾上腺素(NE)水平的变化。结果:观察组的手术时间明显长于对照组(P<0.05),术中出血量及术后住院时间低于对照组(P<0.05);两组的结石清除率比较无统计学差异(P>0.05)。观察组的并发症发生率低于对照组(P<0.05)。术后24 h,两组患者的血清IL-6、CRP、Cor、ACTH、NE水平均较治疗前显著升高,且对照组以上指标均明显高于观察组(P<0.05)。结论:输尿管软镜碎石术与经皮肾镜碎石术治疗直径≤2 cm的肾结石的临床效果相当,但输尿管软镜碎石术导致的术中出血量更少,引起的炎症反应及应激反应更轻,安全性更高。

Objective: To investigate the clinical effect of flexible ureteroscopic lithotripsy and percutaneous nephrolithotripsy on the renal calculi and its influence on the inflammatory response and stress response. Methods: 96 patients with kidney stones admitted to our hospital from January 2018 to May 2019 were selected as the study subjects. They were divided into the observation group and the control group according to the treatment methods with 48 cases in each group. The observation group was treated with flexible ureteroscope lithotripsy, while the control group was treated with percutaneous nephrolithotripsy. The changes of serum interleukin-6(IL-6), C-reactive protein(CRP), cortisol(Cor), adrenocorticotropic hormone(ACTH) and norepinephrine(NE) levels before and after treatment were compared between the two groups. Results: The operation time of observation group was significantly longer than that of the control group(P<0.05), the amount of bleeding during operation and the length of hospitalization after operation were lower than those of the control group. There was no significant difference in the stone clearance rate between the two groups(P>0.05). The incidence of complications in the observation group was lower than that in the control group(P<0.05). At 24 hours after operation, the serum levels of IL-6, CRP, Cor, ACTH and NE in the two groups were significantly higher than those before treatment, and the above indexes in the control group were significantly higher than those in the observation group(P<0.05). Conclusions: The clinical effect of flexible ureteroscopic lithotripsy was similar to that of percutaneous nephrolithotripsy in the treatment of kidney stones less than 2 cm in diameter. However, flexible ureteroscopic lithotripsy caused less intraoperative bleeding, less inflammatory reaction and stress response with higher safety.