输尿管双镜联合治疗2型糖尿病合并复杂性输尿管结石的效果及术后脓毒症发生的影响因素

Effect of Ureteroscopy Combined with Lithotripsy in the Treatment of Type 2 Diabetes Mellitus Complicated with Ureteral Calculi and the Influencing Factors of Postoperative Sepsis

目的 探讨输尿管双镜联合治疗2型糖尿病(T2DM)合并复杂性输尿管结石的疗效及术后脓毒症发生影响因素。方法 选取2021年3月—2023年4月收治的T2DM合并复杂性输尿管结石210例,随机分为观察组和对照组各105例。观察组行输尿管双镜联合治疗,对照组行微创经皮肾镜下取石术。比较2组围术期指标、结石清除率,术前、术后3 d及5 d血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)、空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平,并统计2组术后2周无脓毒症生存率,分析T2MD合并复杂性输尿管结石术后发生脓毒症的影响因素。结果 观察组手术时间长于对照组,血尿持续时间、术后住院时间短于对照组,术中出血量少于对照组(P<0.01)。观察组术后7 d及1个月结石清除率高于对照组(P<0.01)。2组术后3 d CRP、TNF-α、IL-6及FPG、HbA1c均较术前升高,但观察组低于对照组(P<0.05,P<0.01);2组术后5 d CRP、TNF-α、IL-6及FPG、HbA1c较术前、术后3 d下降(P<0.05)。术后2周,2组无脓毒症生存率比较差异无统计学意义(P>0.05)。性别、年龄、体质量指数、术前尿培养阳性及术后3 d、5 d血清CRP、TNF-α、IL-6、FPG、HbA1c均为T2MD合并复杂性输尿管结石患者术后脓毒症发生的影响因素(P<0.01)。结论 输尿管双镜联合治疗T2DM合并复杂性输尿管结石患者,结石清除效果及安全性颇佳,且可有效减轻机体炎症反应、有利于控制血糖水平,但应重视术后脓毒症发生的影响因素。

Objective To investigate the effect of ureteroscopy combined with lithotripsy in the treatment of type 2 diabetes mellitus(T2DM)complicated with ureteral calculi and the influencing factors of postoperative sepsis.Methods A total of 210 patients with T2DM complicated with ureteral calculi treated from March 2021 to April 2023 were selected and randomly divided into observation group(n=105)and control group(n=105).The observation group underwent ureteroscopy combined with lithotripsy,and the control group underwent minimally invasive percutaneous nephrolithotomy.Perioperative indicators,stone clearance rate,serum C reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),fasting plasma glucose(FPG),and glycosylated hemoglobin(HbA1c)levels before surgery,and at 3 and 5 d after surgery were compared between the two groups.The survival rate without sepsis in two groups at 2 weeks after surgery was recorded.The influencing factors of sepsis after surgery for T2MD complicated ureteral calculi were analyzed.Results The duration of operation of the observation group was longer than that of the control group,the duration of hematuria and length of postoperative hospital stay were shorter than those of the control group,and the amount of intraoperative blood loss was less than that of the control group(P<0.01).The stone clearance rate of the observation group was higher than that of the control group at 7 d and 1 month after operation(P<0.01).The levels of CRP,TNF-α,IL-6,FPG and HbA1c in the two groups at 3 d after operation were higher than those before operation,and lower in the observation group than in the control group(P<0.05,P<0.01).CRP,TNF-α,IL-6,FPG and HbA1c in the two groups were decreased at 5 d after operation,as compared with those before and at 3 d after operation(P<0.05).At 2 weeks after surgery,there was no significant difference in the survival rate without sepsis between the two groups(P>0.05).Gender,age,body mass index,positive urine culture before surgery,and serum CRP,TNF-α,IL-6,FPG and HbA1c at 3 and 5 d after surgery were all influencing factors for postoperative sepsis in T2MD patients with complex ureteral calculi(P<0.01).Conclusion In the treatment of T2DM patients with complex ureteral calculi,ureteroscopy combined with lithotripsy has good efficacy and safety in stone removal,and can effectively reduce the inflammatory response of the body and help control the level of blood sugar.However,attention should be paid to the factors affecting the occurrence of postoperative sepsis.