输尿管镜下钬激光碎石治疗对复杂性输尿管结石合并肾盂积水患者炎症指标的影响

Effect of holmium laser lithotripsy under ureteroscope oninflammation indexes in patients with complicatedupper ureteral calculi with hydronephrosis

目的:探讨输尿管镜下钬激光碎石治疗对复杂性输尿管结石合并肾盂积水者炎症指标的影响。方法:回顾2016年10月-2018年9月收治92例复杂性输尿管结石合并肾盂积水患者临床资料,其中47例行输尿管钬激光碎石术(激光组),45例行输尿管气压弹道碎石术(气压弹道组)。比较两组患者的手术效果及肾盂积水恢复情况,观察患者肾功能指标及炎症指标水平变化。结果:激光组手术时间及住院时间均小于气压弹道组(P<0.05);激光组结石清除率及肾盂积水恢复情况均明显优于气压弹道组(P<0.05),而激光组术后输尿管穿孔发生率低于气压弹道组(P<0.05);激光组术后血肌酐、中性粒细胞明胶酶相关载脂蛋白、尿肾损伤因子-1及血降钙素原、超敏C反应蛋白、肿瘤坏死因子-α水平均显著低于气压弹道组(P<0.05)。结论:输尿管镜下钬激光碎石术治疗复杂性输尿管结石效果良好,可有效改善肾盂积水情况,促进肾功能恢复和降低机体炎症状况。

Objective:To investigate the effect of holmium laser lithotripsy under ureteroscope on inflammatory indexes in patients with complicated upper ureteral calculi with hydronephrosis.Methods:The clinical data of 92 cas⁃es of complicated upper ureteral calculi complicated with hydronephrosis from October 2016 to September 2018 were reviewed.Forty-seven patients received ureteral holmium laser lithotripsy(laser group)and 45 patients received ure⁃teral pneumatic lithotripsy(pneumatic group).The surgery effect and the recovery of hydronephrosis were compared between two groups.The changes of renal function and inflammation were observed.Results:The operation time and hospital stay in laser group were significantly reduced as compared with those in pneumatic group(P<0.05).The stone clearance rate and the recovery rate of hydronephrosis in laser group were significantly higher in laser group than in pneumatic group(P<0.05),while the incidence of ureteral perforation in laser group was significantly lower than in pneumatic group(P<0.05).Serum creatinine(Scr),neutrophil gelatin-associated apolipoprotein(NGAL),urinary kidney injury factor-1(KIM-1),serum procalcitonin(PCT),hypersensitive C-reactive protein(hs-CRP),and tumor necrosis factor-α(TNF-α)levels in laser group were significantly lower than those in pneumatic group(P<0.05).Conclusion:Holmium laser lithotripsy under ureteroscope has a good effect in the treatment of compli⁃cated upper ureteral calculi,which can effectively improve the situation of hydronephrosis,promote the recovery of re⁃nal function and reduce inflammation.