单孔后腹腔镜输尿管切开取石术对输尿管上段结石患者术后结石清除率及血清sVCAM-1、ESR水平的影响

Effects of single-site retroperitoneal ureterolithotomy on postoperative stone clearance rate and serum sVCAM-1 and ESR levels in patients with upper ureteral calculi

目的:探讨单孔后腹腔镜输尿管切开取石术对输尿管上段结石患者术后结石清除率及血清可溶性血管细胞黏附分子-1(sVCAM-1)、血沉(ESR)水平的影响。方法:选取2014年2月~2016年10月我院78例输尿管上段结石患者,采用随机数字表法将患者分为对照组(n=39)与研究组(n=39)。对照组采用常规腹腔镜输尿管切开取石术,研究组采用单孔后腹腔镜输尿管切开取石术。对比两组围手术期情况[手术用时、术中出血量、术后疼痛评分(VAS)、住院时间]、术后1周及4周结石清除率、入院时及术后血清sVCAM-1和ESR水平变化情况、并发症发生率。结果:两组手术用时比较差异无统计学意义(P>0.05),研究组术中出血量、VAS评分及住院时间均小于对照组,差异有统计学意义(P<0.05);两组术后1周及4周的结石清除率比较差异无统计学意义(P>0.05);术后两组血清sVCAM-1水平较术前增,ESR水平较术前降低,但研究组sVCAM-1水平低于对照组,ESR水平高于对照组,差异有统计学意义(P<0.05);研究组并发症发生率低于对照组,差异有统计学意义(7.69%vs.25.64%,P<0.05)。结论:采用单孔后腹腔镜输尿管切开取石术治疗输尿管上段结石效果显著,可减少手术用时及失血量,术后疼痛感较轻,结石清除率较高,对血清sVCAM-1、ESR水平影响小,且并发症发生率较低,具有安全性。

Objective：To investigate the effect of single-site retroperitoneal ureterolithotomy on postoperative stone clearance rate,serum soluble vascular cell adhesion molecule-1（sVCAM-1）and erythrocyte sedimentation rate（ESR）levels in patients with upper ureteral calculi.Method：From February 2014 to October 2016,we selected 78 patients with upper ureteral calculi in Shangqiu first people＇s hospital,and they were randomly divided into control group（n=39）and study group（n=39）.The control group were treated with conventional laparoscopic ureteroscopy,while the study group were treated with single-site retroperitoneal ureterolithotomy.Perioperative clinical data [surgery time,intraoperative blood loss,postoperative pain score（VAS）,hospital stay],stone clearance rate at one week and four weeks after operation,serum sVCAM-1 and ESR levels at admission and after operation,the incidence of complications were compared between the two groups.Result：There was no significant difference in surgery time between the two groups（P0.05）,the intraoperative blood loss,VAS score and hospital stay in the study group were less than those in the control group,the difference was statistically significant（P0.05）.There was no significant difference in stone clearance rate at one week and four weeks after operation between the study group and the control group（P0.05）.The serum sVCAM-1 level in the two groups after operation were both higher than those before operation,ESR level was lower than those before operation.However,the sVCAM-1 level in the study group was lower than that in the control group,and the ESR level was higher than that in the control group,the difference was statistically significant（P0.05）.The incidence of complications in the study group was lower than that in the control group,the difference was statistically significant（7.69% vs. 25.64%,P0.05）.Conclusion：Patients with upper ureteral calculi treated by single-site retroperitoneal ureterolithotomy gets a significant effect,which can reduce the operation time and blood loss,the postoperative pain is mild and stone clearance rate is high.Also,it has little effect on serum sVCAM-1 and ESR,and the incidence of complications is low,with higher safety.