输尿管软镜下两种治疗方案在嵌顿性输尿管上段结石患者中的应用效果对比

Comparison of efficacy of two treatment regimens under ureteroscope in patients with calculi in incarcerated upper ureteral duct

目的对比输尿管软镜下两种治疗方案治疗嵌顿性输尿管上段结石患者中的应用效果.方法回顾性分析2016年1月5日至2017年2月9日在本院接受治疗并确诊为嵌顿性输尿管上段结石的患者86例,其中采用一步法的患者43例为观察组,采用分步法的患者43例为对照组,两组患者在年龄、基本情况、病情等方面比较,差异无统计学意义(P>0.05).在术后对两组患者进行尿液细菌培养及药敏试验,并定期进行复查.比较两组的手术时间、手术成功率、结石清除率、术后并发症情况、术后1d测量炎症因子的反应水平及应激反应相关因子.结果观察组手术时间及住院时间明显少于对照组,差异有统计学意义(P<0.05);手术成功率观察组为93.13%(40/43)高于对照组的81.39%(35/43),差异有统计学意义(P<0.05),在术后残石清除率方面,两组比较差异无统计学意义(P>0.05).两组患者的炎症因子、肿瘤坏死因子-a(TNF-a)及白细胞介素-10(IL-10),术前两组比较差异无统计学意义(P>0.05),但术后1、3、5d比较,观察组均低于对照组,差异有统计学意义(P<0.05);两组患者的氧化应激物中的丙二醛(MDA)及晚期氧化蛋白产物(AOPP)术前比较差异均无统计学意义(P>0.05),术后1、3、5d,观察组与对照组均呈下降趋势,但是观察组均低于对照组,差异有统计学意义(P<0.05);两组患者的抗氧化物质谷胱甘肽过氧化物酶(GSH-PX)及超氧化物歧化酶(SOD)术前比较均无统计学意义(P>0.05),术后1、3、5d,两组均呈升高趋势,但观察组高于对照组,差异有统计学意义(P<0.05).结论一步法碎石术在一定程度上缩短了手术时间,在术中有良好的手术视野,能有效地保障手术质量及手术时间,在术后患者的发热、炎症发生率低,而且在一定程度上少了患者的医疗费用,较分步法有明显的应用优势.

Objective To compare the efficacy of two treatment regimens under ureteroscope in the treatment of calculi in incarcerated upper ureteral duct. Methods A retrospective analysis on January 2016 to February 2017 in our hospital for treatment and diagnosis of 86 patients with calculi in incarcerated upper ureteral duct, 55 cases of men and women in 31 cases, aged 29-69 years, the av-erage age was (38. 5 ± 7. 4) years old. One step method of 43 cases of observation group, 43 patients accepted the fractional step method for the control group, two groups of patients in such aspects as age, basic situation, condition, there was no statistically significant difference(P>0. 05). Postoperative u-rine bacterial culture and drug sensitivity test were conducted on 2 groups of patients, and regular reex-amination was conducted. Two groups of operation time, surgical success rate, stone clearance rate, postoperative complications, postoperative fever rate to 38. 5℃temperature acuity, 2 groups of patients in postoperative 1 day the reaction levels of inflammatory markers measurement and stress related fac-tors were compared. Results The average operation time of observation group was ( 37. 45 ± 3. 40 ) min, and the operation time of control group was (55. 45 ± 4. 80) min, the time of observation group was obviously less than control group(P<0. 05), length of hospital stay of observation group was obvi-ously shorter than the control group(P<0. 05), surgical success rate of observation group was higher than that of control group, there was statistically significant(P<0. 05), in terms of postoperative re-sidual stone clearance, observation group was 95. 34%, the control group was 93. 13%. The compari-son between the two groups was not statistically significant(P>0. 05). Two groups of patients in post-operative body temperature of 38. 5℃or higher, observation group occurred in 1 case, 12 cases of con-trol group. There was no statistical significance in inflammatory factor, tumor necrosis factor-a( TNF-a) and interleukin-10(IL-10) before surgery(P>0. 05), but in postoperative 1, 3, 5 d, observation group was lower than the control group(P<0. 05). There was no statistical significance in two groups of the malondialdehyde( MDA) in oxidative stress and the advanced oxidation protein products( AOPP)(P>0. 05), and 1, 3, 5 d after surgery, the observation group and control group decreased, but the observation group was lower than the control group, with statistical significance(P<0. 05). There was no statistical significance in antioxidant glutathione peroxidase ( GSH-PX ) and superoxide dismutase (SOD) of two groups(P>0. 05). Conclusions One-step lithotripsy can shorten the operation time, has a good surgical field in operation, it can effectively guarantee the operation quality and the opera-tion time, the low incidence of postoperative patients with fever and inflammation, reduce the patient's medical expenses, the fractional step method has obvious application advantages.