后腹腔镜与经皮肾镜用于复杂性输尿管上段结石治疗的术后创伤程度比较

Comparison of trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi

目的:对比后腹腔镜与经皮肾镜用于复杂性输尿管上段结石治疗的术后创伤程度。方法:选取2013年7月~2015年1月间在本院接受手术治疗的82例复杂性输尿管上段结石患者纳入研究。根据具体手术方式选择不同,入组对象被随机分为观察组及对照组各41例。对照组接受经皮肾镜治疗,观察组接受后腹腔镜治疗,比较两组术后早期凝血指标、血糖及胰岛素水平、应激蛋白质水平、PI3K/Akt及p38MAPK信号通路表达差异。结果:观察组术后早期PLCR、PDW、APTT、D-D值低于对照组,Ca^(2+)值高于对照组(P<0.05);观察组术后早期GLU、空腹乳酸、空腹乳酸/丙酮酸、HOMA-IR值低于对照组,HOMA-β值高于对照组(P<0.05);观察组术后早期HSP70、DNA ligaseⅣ、JAB1、ATF4表达量高于对照组,β-tubulin、IFIT1表达量低于对照组(P<0.05);观察组术后早期p38MAPK mRNA及蛋白质表达量均低于对照组,PI3K、Akt mRNA及蛋白质表达量高于对照组(P<0.05)。结论:复杂性输尿管上段结石患者采用后腹腔镜治疗,对患者带来的创伤较小、内环境影响较少,有助于患者术后早期康复。

Objective：To compare the trauma degree after retroperitoneoscopy and percutaneous nephtoscopy treatment of complicated upper ureteral calculi.Methods：A total of 82 patients with complicated upper ureteral calculi who received surgical treatment in our hospital from July 2013 to January 2015 were included for study.According to the different surgical methods,included subjects were randomly divided into observation group 41 cases and control group 41 cases.Control group received percutaneous nephtoscopy treatment,observation group received retroperitoneoscopy treatment,and then differences in early postoperative coagulation indicators,blood glucose and insulin levels,stress protein levels as well as PI3K/Akt and p38 MAPK signaling pathway expression were compared between two groups.Results：Early postoperative PLCR,PDW,APTT and D-D values of observation group were lower than those of control group while Ca^2＋value was higher than that of control group（P〈0.05）;early postoperative GLU,fasting lactate,fasting lactate/pyruvic acid and HOMA-IR values of observation group were lower than those of control group while HOMA-βvalue was higher than that of control group（P〈0.05）;early postoperative HSP70,DNA ligaseⅣ,JAB1 and ATF4expression levels of observation group were higher than those of control group whileβ-tubulin and IFIT1 expression levels were lower than those of control group（P〈0.05）;early postoperative p38 MAPK mRNA and protein expression levels of observation group were lower than those of control group while PI3 K and Akt mRNA and protein expression levels were higher than those of control group（P〈0.05）.Conclusion：Retroperitoneoscopy treatment of patients with complicated upper ureteral calculi causes less injury to patients and less effect on internal environment,and helps to patients＇ early postoperative rehabilitation.