腹腔镜和输尿管镜手术用于输尿管上段复杂性结石治疗的效果及神经体液变化的评估

Effect and neurohumoral changes of laparoscopic and ureteroscopic surgery for treatment of complicated upper ureteral calculi

目的：分析腹腔镜和输尿管镜手术用于输尿管上段复杂性结石治疗的效果及神经体液变化。方法：选择2014年3月-2016年3月在本院接受手术治疗的输尿管上段复杂性结石患者92例,随机分为观察组及对照组,每组46例。对照组患者接受输尿管镜手术治疗,观察组患者接受腹腔镜输尿管切开取石治疗。观察两组患者的手术成功率及取石成功率;术后6h时,检测神经体液指标。结果：观察组患者的手术成功率及结石清除率高于对照组患者;术后6h时,观察组患者的血清肾功能指标胱抑素C（CysC）、尿素（Urea）、肌酐（Cr）含量低于对照组患者,血清炎症因子白介素-1β（IL-1β）、白介素-6（IL-6）、白介素-8（IL-8）、降钙素原（PCT）、肿瘤坏死因子-α（TNF-α）、超敏C反应蛋白（hs-CRP）含量低于对照组患者,血清应激激素皮质醇（Cor）、醛固酮（ALD）、去甲肾上腺素（NE）、血管紧张素Ⅱ（Ang-Ⅱ）、促肾上腺皮质激素（ACTH）含量低于对照组患者,血清单胺类神经递质高香草酸（HVA）、5-羟吲哚乙酸（5-HIAA）含量低于对照组患者,3-甲基-4-羟基苯乙二醇（MHPG）含量高于对照组患者,差异均具有统计学意义（P〈0.05）。结论：腹腔镜输尿管切开取石可提升输尿管上段复杂性结石患者的治疗有效性及安全性,是更为理想的取石方式。

Objective：To analyze the effects and neurohumoral changes of laparoscopic and ureteroscopic surgery for treatment of complicated upper ureteral calculi.Methods：A total of 92 patients with complicated upper ureteral calculi who received surgical treatment in our hospital were selected and randomly divided into observation group（n=46）and control group（n=46）,control group received ureteroscopic surgery and observation group received laparoscopic ureterolithotomy.Surgical success rate and calculus removal success rate of two groups of patients were observed;6hafter operation,neurohumoral indexes were detected.Results：Surgical success rate and calculus removal rate of observation group were higher than those of control group;6hafter operation,renal function indexes CysC,Urea and Cr content in serum of observation group were lowerthan those of control group,inflammatory factors IL-1β,IL-6,IL-8,PCT,TNF-αand hs-CRP content in serum were lower than those of control group,stress hormones Cor,ALD,NE,Ang-Ⅱ and ACTH content in serum were lower than those of control group,and monoamine neurotransmitters HVA and 5-HIAA content in serum were lower than those of control group while MHPG content was higher than that of control group.Conclusion：Laparoscopic ureterolithotomy can improve the treatment effectiveness and safety for patients with complicated upper ureteral calculi,and it is a more ideal way of lithotomy.