微创经皮肾镜取石术和单孔后腹腔镜输尿管切开取石术治疗输尿管上段结石的对比研究

Controlled study on minimally invasive percutaneous nephrolithotomy and laparo-endoscopic single-site ureterolithotomy treatment of upper ureteral calculi

目的:分析微创经皮肾镜取石术和单孔后腹腔镜输尿管切开取石术治疗输尿管上段结石的效果差异。方法:116例输尿管上段结石患者在本院接受治疗并纳入研究,根据接受的手术方式不同,分为观察组及对照组,各58例。对照组接受微创经皮肾镜取石术治疗,观察组接受单孔后腹腔镜输尿管切开取石术治疗,对比两组术后早期应激及代谢指标、细胞黏附分子、血液流变学特性、Th1/Th2因子水平等差异。结果:观察组术后早期血清皮质醇(COR)、促肾上腺皮质激素(ACTH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、白细胞(WBC)值低于对照组,促甲状腺激素(TSH)值高于对照组(P<0.05);观察组术后早期可溶性分化抗原44拼接变异体6(sCD44v6)、可溶性细胞间黏附分子-1(sICAM-1)、可溶性血管细胞黏附分子-1(sVCAM-1)、可溶性上皮钙黏素(sE-cadherin)值均低于对照组(P<0.05);观察组治疗后全血黏度(WBV)、血浆黏度(PV)、红细胞刚性指数(RI)、红细胞聚集指数(EAI)值低于对照组,红细胞压积(HCT)、血沉(ESR)、血沉方程K值(ESR K)值高于对照组(P<0.05);观察组治疗后血清干扰素-γ(IFN-γ)、白介素-2(IL-2)值高于对照组,白介素-4(IL-4)、白介素-10(IL-10)值低于对照组(P<0.05)。结论:单孔后腹腔镜输尿管切开取石术可以有效去除输尿管上段结石患者的结石嵌顿,兼具微创及高效等特性,是更为理想的临床治疗方式。

Objective：To analyze the differences on the effect of minimally invasive percutaneous nephrolithotomy and laparoendoscopic single-site ureterolithotomy treatment of upper ureteral calculi.Methods：A total of 116 cases of patients with upper ureteral calculi were treated in our hospital and included in the research,and according to different surgical ways they received,they were divided into observation group and control group,58 cases in each group.Control group received minimally invasive percutaneous nephrolithotomy treatment,observation group received laparoendoscopic single-site ureterolithotomy treatment,and then differences in the levels of early postoperative stress and metabolic indexes,cell adhesion molecules,hemorrheological properties,Th1/Th2 factors,etc.were compared between two groups.Results：Early postoperative serum cortisol（COR）,adrenocorticotropic hormone（ACTH）,free triiodothyronine（FT3）,free thyroxine（FT4）and white blood cell（WBC）values of observation group were significantly lower than those of control group while thyroid stimulating hormone（TSH）value was significantly higher than that of control group（P〈0.05）;early postoperative sCD44v6,sICAM-1,sVCAM-1and sE-cadherin values of observation group were significantly lower than those of control group（P〈0.05）;whole blood viscosity（WBV）,plasma viscosity（PV）,rigidity index（RI）and erythrocyte aggregation index（EAI）values of observation group after treatment were significantly lower than those of control group while hematokrit（HCT）,erythrocyte sedimentation rate（ESR）and ESR K values were significantly higher than those of control group（P〈0.05）;serum interferon（IFN）-γand interleukin（IL）-2values of observation group after treatment were significantly higher than those of control group while IL-4and IL-10 values were lower than those of control group（P〈0.05）.Conclusions：Laparoendoscopic single-site ureterolithotomy can effectively remove incarcerated stone in patient with upper ureteral calculi,with minimal invasion,efficiency and other properties,and is a more ideal clinical treatment.