无管化PCNL治疗嵌顿性输尿管上段结石的效果及对患者血清炎症因子的影响

Effect of tubeless PCNL in the Treatment of Incarcerated Upper Ureteral Calculi and its Influence on Serum Inflammatory Factors

【目的】探讨无管化经皮肾镜取石手术(tubeless PCNL)治疗嵌顿性输尿管上段结石的效果及对患者血清炎性因子水平的影响。【方法】选取本院收治的120例嵌顿性输尿管上段结石患者的临床资料,根据手术方法分为观察组(采用tubeless PCNL手术)和对照组(采用后腹腔镜手术),各60例。比较两组手术时间、术中出血量、术后住院时间、术后镜下血尿持续时间、结石清除率,手术前后血清白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、前列腺素E2(PGE2)、肿瘤坏死因子-α(TNF-α)水平。【结果】观察组手术时间、术中出血量、术后住院时间低于对照组,术后肉眼血尿持续时间长于对照组,差异均有统计学意义(P<0.05)。术后3 d、术后1个月复查,对照组结石清除率均为100.00%(60/60),观察组分别为93.33%(56/60)、98.33%(59/60),差异均无统计学意义(均P>0.05)。观察组术后并发症发生率为5.00%(3/60)低于对照组的16.67%(10/60),差异有统计学意义(χ^2=4.227,P=0.04<0.05)。术后24 h,观察组血清IL-6、PGE2、TNF-α水平低于对照组(P<0.05),血清IL-2水平高于对照组,差异有统计学意义(P<0.05)。【结论】tubeless PCNL治疗嵌顿性输尿管上段结石的结石清除率与后腹腔镜手术差异不大,但手术创伤更小、术后恢复更快、并发症更少、炎症反应程度更轻。

【Objective】To investigate the effect of tubeless percutaneous nephrolithotomy (PCNL) in the treatment of incarcerated upper ureteral calculi and its influence on serum inflammatory factors.【Methods】The clinical data of 120 patients with incarcerated upper ureteral calculi in our hospital were selected and divided into observation group (tubeless PCNL operation) and control group (retroperitoneal laparoscopic operation),60 cases each.The operation time,intraoperative bleeding volume,hospital stay,duration of hematuria and stone clearance rate,serum levels of interleukin-2 (IL-2),interleukin-6 (IL-6),prostaglandin E2 (PGE2) and tumor necrosis factor-α(TNF-α) before and after operation were compared between the two groups.【Results】The operation time,intraoperative bleeding volume and hospitalization time of the observation group were lower than those of the control group,and the duration of naked hematuria after operation was longer than that of the control group (P<0.05).The stone clearance rate of the control group was 100.00%(60/60),while that of the observation group was 93.33%(56/60) and 98.33%(59/60),respectively,with no significant difference (P>0.05).The incidence of postoperative complications in the observation group was 5.00%(3/60) lower than that in the control group 16.67%(10/60).The difference was statistically significant (χ2=4.227,P=0.04<0.05).24 hours after operation,the serum levels of IL-6,PGE2 and TNF-alpha in the observation group were lower than those in the control group (P<0.05),and the serum levels of IL-2 were higher than those in the control group (P<0.05).【Conclusion】The stone clearance rate of tubeless PCNL in the treatment of incarcerated upper ureter calculi is not significantly different from that of retrolaparoscopic surgery,but the trauma is smaller,the postoperative recovery is faster,the complications are fewer,and the degree of inflammatory reaction is less.