mPCNL联合输尿管软镜治疗老年嵌顿性输尿管上段结石的疗效及对炎性指标的影响

Effect of Minimally Percutaneous Nephrolithotomy with Flexible Ureteroscopy for Elderly Patients with Impacted Upper Ureteral Calculi and Its Influence on Inflammatory Indicators

目的探讨微创经皮肾取石术(mPCNL)联合输尿管软镜治疗老年嵌顿性输尿管上段结石的疗效,及其对炎性指标的影响。方法将76例老年嵌顿性输尿管上段结石患者采用数字表法随机分为联合组与对照组,各38例,联合组采用mPCNL+输尿管软镜,对照组单纯采用mPCNL进行治疗,比较分析两组围术期相关指标、术后并发症及复发情况,手术前后IL-6水平的变化。结果与对照组相比,联合组手术时间明显增加,碎石成功率明显升高,结石排净时间、术后住院时间明显缩短(P<0.05);术后第1、3天,两组IL-6水平明显升高,而联合组术后第5天IL-6基本恢复至术前水平,且术后第1、3、5天IL-6水平均明显低于对照组(P<0.05);联合组的并发症发生率为15.8%,显著低于对照组36.8%(P<0.05);联合组术后6个月复发率为2.6%,显著低于对照组15.8%(P<0.05)。结论 mPCNL联合输尿管软镜可提高结石清除率,减轻炎性反应,降低围术期并发症和术后复发,尤其适用于老年嵌顿性输尿管上段结石患者。

Objective To explore the efficacy of minimally percutaneous nephrolithotomy（mPCNL） with flexible ureteroscopy on the treatment of elderly patients with impacted upper ureteral calculi, and its influence on inflammatory indicators. Methods Seventy six elderly patients with impacted upper ureteral calculi were treated by mPCNL alone （control group, n=38） and mPCNL combined with flexible ureteroscopy （combined group, n=38）. The related perioperative parameters, postoperative complications and recurrence, change of IL-6 before and after surgery between two groups were comparatively analyzed. Results Compared with control group, the operation time in combined group was increased, while the success rate of lithotripsy was increased significantly, the time of stone free, postoperative hospitalization was significantly shortened （P 〈 0.05）. At 1^st, 3^rd day after surgery, the levels of IL-6 increased significantly in both groups, and it recovered to preoperative levels at 5th day after surgery in combined group, and the levels of IL-6 At 1^st, 3^rd, 5^th day after surgery in combined group were significantly lower than those in control group （P 〈 0.05）. The incidence of complications in combined group was 15.8%, significantly lower than 36.8% in control group （P 〈 0.05）. The postoperative recurrence within 6 months in combined group was 2.6%, significantly lower than 15.8% in control group （P 〈 0.05）. Conclusion mPCNL with flexible ureteroscopy can improve calculi clearance rate, reduce inflammatory reactionand, perioperative complications and postoperative recurrence, especially suitable for elderly patients with impacted upper ureteral calculi.