经皮肾镜超声碎石术在感染性肾结石中的疗效及对患者应激激素的影响观察

Effect of percutaneous nephrolithotomy with ultrasound lithotripsy on infective renal calculi

目的观察经皮肾镜超声碎石术治疗对于感染性肾结石中病患应激激素分泌的影响,分析该法的治疗价值。方法选择2013年10月-2015年8月医院进行经皮肾镜超声碎石术治疗的感染性肾结石患者89例为超声组,另选同期气道弹压碎石治疗的89例感染性结石病患为气道弹压组,观察治疗前后两组患者血清应激激素、应激炎性指标的变化,并对比组间疗效和并发症。结果超声组手术时间(69.72±9.58)min、术后住院时间(6.82±1.29)d、术中出血(75.26±15.64)ml明显低于对照组,差异有统计学意义(P<0.05);治疗后,超声组血管紧张素-Ⅱ(Ang-Ⅱ)(52.27±3.54)pg/ml、促肾上腺皮质激素(ACTH)(26.17±2.97)pg/ml、去甲肾上腺素(NE)(275.08±23.01)ng/ml、皮质醇(Cor)(171.65±9.54)ng/ml、肾上腺素(AD)(0.23±0.09)ng/ml、降钙素原(PCT)(23.45±0.56)μg/ml、白介素-6(IL-6)(9.52±1.64)pg/ml、超敏C-反应蛋白(hs-CRP)(7.69±1.89)mg/L、一氧化氮(NO)(12.21±1.31)μmol/L明显低于气道弹压组,差异有统计学意义(P<0.05);超声组临床疗效(88.76%)明显高于对照组66.29%,差异有统计学意义(P<0.05)。结论经皮肾镜超声碎石术治疗感染性肾结石不仅具有较高的取净率、术后恢复快,而且对患者应激指标影响小、手术安全性更高。

OBJECTIVE To observe the effect of percutaneous nephrolithotomy on stress hormone secretion in patients with infectious kidney stones,and analyze its therapeutic value.METHODS A total of 89 patients of infectious nephrolithiasis with percutaneous nephroscope ultrasound lithotripsy from Oct.2013 to Aug.2015 in our hospital were retrospectively chosen as ultrasound group,and another 89 infectious stones patients with airway crushed stone treatment at the same period were chosen as airway pressure group.The changes of serum stress hormones and stress inflammatory indexes of the two groups before and after treatment were observed,and the curative effect and complication between the two groups were compared.RESULTS The mean operative time[（69.72 ± 9.58）min],postoperative hospital stay[（6.82 ± 1.29）]days and intraoperative bleeding[（75.26 ± 15.64）]ml of ultrasound group were significantly lower than those of control group（P〈0.05）.After treatment,the levels of Ang-Ⅱ[（52.27±3.54）pg/ml],ACTH[（26.17±2.97）pg/ml],NE[（275.08±23.01）ng/ml],Cor[（171.65±9.54）ng/ml],AD[（0.23±0.09）ng/ml],PCT[（23.45±0.56）μg/ml],IL-6[（9.52±1.64）pg/ml],hs-CRP[（7.69±1.89）mg/L],and NO[（12.21±1.31）μmol/L]were significantly lower than those of control group（P〈0.05）.The clinical efficacy of ultrasound group（88.76%）was significantly higher than 66.29% of control group,and the difference was statistically significant（P〈0.05）.CONCLUSION Percutaneous nephrolithotomy with ultrasonic lithotripsy is a safe and effective method for the treatment of infectious nephrolithiasis,and it is with high exhaustion rate and rapid postoperative recovery,and has little effect on patients＇ stress indicators.