腹腔镜输尿管切开取石术治疗输尿管上段复杂性结石的应用研究

Study on the application of laparoscopic ureterolithotomy for complicated calculi of upper ureter

目的:探讨腹腔镜输尿管切开取石术对输尿管上段复杂性结石患者术后血清3-甲氧基4-羟基苯乙二醇(MHPG)、降钙素原(procalcitonin,PCT)、胱抑素C(cystatin C,CysC)水平的变化及生活质量的影响。方法:选取2015年10月至2017年7月收治的68例输尿管上段复杂性结石患者,根据随机数字表法分为对照组(n=34)与研究组(n=34)。对照组行微创经皮肾镜取石术,研究组行腹腔镜输尿管切开取石术。统计两组手术情况(手术时间、术中失血量、结石清除率)、术后康复情况(下床活动时间、住院时间)、并发症及手术前后血清MHPG、PCT、CysC水平、生活质量(SF-36)评分。结果:研究组术中失血量较对照组减少,手术时间长于对照组(P<0.05);两组结石清除率(100.00%vs.97.06%)差异无统计学意义(P>0.05);研究组下床活动时间、住院时间优于对照组(P<0.05);两组患者术后血清MHPG水平较术前降低,PCT、CysC水平较术前增高,研究组血清MHPG水平高于对照组,PCT、CysC水平低于对照组(P<0.05);术后1个月,两组SF-36分值较术前增高,研究组高于对照组(P<0.05);研究组并发症发生率(8.82%)低于对照组(32.35%,P<0.05)。结论:腹腔镜输尿管切开取石术治疗输尿管上段复杂性结石可减少手术创伤,促使机体功能康复,且可抑制血清MHPG、PCT、CysC水平的变化,减少术后并发症,改善患者生活质量。

Objective： To investigate the effect of laparoscopic ureterolithotomy on serum levels of MHPG,procalcitonin（ PCT）,cystatin C（ CysC） and quality of life in patients with complicated calculi of upper ureter. Methods： A total of 68 patients with complicated calculi of upper ureter from Oct. 2015 to Jul. 2017 were selected and randomly divided into control group（ n = 34） and study group（ n = 34）. The control group was treated with minimally invasive percutaneous nephrolithotomy,and the study group was treated with laparoscopic ureterolithotomy. The operation condition（ operation time,intraoperative blood loss,stone clearance rate）,postoperative rehabilitation（ ambulation time,hospitalization time）,serum MHPG,PCT,CysC levels,quality of life（ SF-36） score and complications of the two groups were statistically analyzed. Results： The intraoperative blood loss in the study group was less than that in the control group,and the operation time was longer than that in the control group（ P〈0. 05）. There wasn＇t any significant difference in the stone clearance rate between the study group and the control group（ 100. 00% vs. 97. 06%,P〈0. 05）. The ambulation time and hospitalization time in the study group was less than that in the control group（ P〈0. 05）. After operation,the serum MHPG levels of two groups decreased,and PCT and CysC levels increased. The serum MHPG level in the study group was higher than that in the control group,and PCT,CysC level was lower than that in the control group（ P〈0. 05）. 1 month after operation,SF-36 score of two groups were higher than those before operation,and the study group was higher than the control group（ P〈0. 05）. The rate of complications in the study group（ 8. 82%） was lower than that in the control group（ 32. 35%,P〈0. 05）. Conclusions： Laparoscopic ureterolithotomy for the treatment of complicated calculi of upper ureter can reduce surgical trauma,promote the body functional rehabilitation,restrain the change of serum MHPG,PCT and CysC levels,reduce postoperative complications and improve the life quality of patients.