输尿管软镜碎石术和经皮肾镜碎石术用于肾结石并复杂尿路感染的效果对比

Effect comparison of flexible ureteroscopy lithotripsy and percutaneous nephrolithotomy for renal calculi combined with complicated urinary tract infection

目的比较输尿管软镜碎石术和经皮肾镜碎石术治疗肾结石并复杂尿路感染时的效果。方法选取2014年2月~2017年2月在我院治疗的110例肾结石并复杂尿路感染患者,随机分为观察组,各55例。观察组行输尿管软镜碎石术,对照组行经皮肾镜碎石术。比较两组的术中出血量、手术时间、住院时间、结石清除率、感染缓减率、并发症发生率以及T淋巴细胞亚群变化情况。结果观察组的术中出血量少于对照组,手术时间以及住院时间短于对照组,差异有统计学意义(P<0.05)。两组的结石清除率和感染缓解率比较,差异无统计学意义(P>0.05)。观察组的术后并发症发生率为3.64%,显著低于对照组的16.36%,差异有统计学意义(P<0.05)。两组手术前后的CD8^+水平比较,差异无统计学意义(P>0.05)。观察组手术前后的CD3^+、CD4^+以及CD4^+/CD8^+水平比较,差异无统计学意义(P>0.05)。对照组术后1、24 h的CD3^+、CD4^+以及CD4^+/CD8^+水平显著低于术前,差异有统计学意义(P<0.05),直到术后72后才恢复。结论相较于经皮肾镜碎石术,输尿管软镜碎石术虽然在结石清除率以及感染缓解率方面无显著优势,但其并发症发生率更低,损伤更小。

Objective To compare the efficacy of flexible ureteroscopic lithotripsy and percutaneous nephrolithotomyin the treatment of renal calculi combined with complicated urinary tract infection.Methods From February 2014 to February 2017,110 cases of renal calculi combined with complicated urinary tract infection in our hospital were select- ed and randomly divided into the observation group and the control group,55 cases in each group.The observation group was treated with flexible ureteroscope lithotripsyland the control group was treated with percutaneous nephrolithotomy. The intraoperative blood loss,operation time,hospitalization time,stone clearance rate,infection reduction rate,the incidence rate of complication and the change of T lymphocyte subsets were compared between the two groups.Results The amount of intraoperative blood loss in the observation group was less than that in the control group,and the operation time and hospitalization time in the observation group was shorter than that of the control group,with significant difference （P〈0.05）.There was no significant difference between the two groups in the rate of stone clearance and the rate of infection remission （P〉0.O5）.The incidence rate of postoperative complications in the observation group was 3.64%, which was significantly lower than 16.36% in the control group,with significant difference （P〈0.05）.There was no signif- icant difference between the two groups before and after the operation in the level of CD8＋（P〉0.05）.There was no significant difference between before and after the operation in the observation group in the levels of CD3＋,CD4＋ and CD4＋/ CD8＋ （P〉0.05）.The levels of CD3＋,CD4＋ and CD4＋/CD8＋ in the control group after the operation at 1 and 24 h was significantly lower than that before the operation,with significant difference （P〈0.05）.The level of CD3＋,CD4＋ and CD4q CD8＋ was recovered until 72 after operation.Conclusion Compared with percutaneous nephrolithotomy,flexible uretero- scopic lithotripsy has no significant advantage in the rate of stone clearance and the remission rate of infection,but the complication rate is lower and the injury is less.