输尿管镜钬激光碎石术与开放手术对输尿管上段结石患者氧化应激和炎性因子的影响

Effects of Ureteroscopic Holmium Laser Lithotripsy and Open Surgery on Oxidative Stress and Inflammatory Factors in Patients with Upper Ureteral Calculi

目的:探讨输尿管镜钬激光碎石术与开放手术对输尿管上段结石患者氧化应激和炎性因子的影响。方法:选取2015年8月~2018年9月期间安徽省中医药大学第一附属医院收治的输尿管上段结石患者117例为研究对象,根据手术方式的不同将患者分为对照组(n=58,开放手术)和观察组(n=59,输尿管镜钬激光碎石术),比较两组患者的治疗效果、氧化应激指标以及炎性因子指标变化情况,观察两组术后并发症发生情况。结果:两组患者结石清除率、结石复发率比较无差异(P>0.05),观察组手术、术后下床、住院的时间均明显短于对照组,术中出血量少于对照组(P<0.05)。两组患者术后3d、术后7d丙二醛(MDA)、皮质醇(Cor)水平均高于术前,且先升高后降低(P<0.05),超氧化物歧化酶(SOD)水平低于术前,且先降低后升高(P<0.05),术后3d、术后7d观察组MDA、Cor水平低于对照组,SOD水平高于对照组(P<0.05)。两组患者术后3d、术后7d白介素-2(IL-2)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平均高于术前,且先升高后降低(P<0.05),术后3d、术后7d观察组IL-2、IL-6、TNF-α水平低于对照组(P<0.05)。观察组术后并发症发生率低于对照组(P<0.05)。结论:输尿管镜钬激光碎石术治疗输尿管上段结石安全有效,同时还可改善临床指标,减轻机体氧化应激与炎性应激反应。

Objective: To investigate the effects of ureteroscopic holmium laser lithotripsy and open surgery on oxidative stress and inflammatory factors in patients with upper ureteral calculi. Methods: 117 patients with upper ureteral calculi who were admitted to the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine from August 2015 to September 2018 were selected as the study subjects. According to the different surgical methods, the patients were divided into control group(n=58, open surgery) and observation group(n=59, ureteroscopic holmium laser lithotripsy). The therapeutic effect, oxidative stress index and inflammation factors index of the two groups were compared. The occurrence of complications after operation in the two groups was observed. Results: There was no significant difference in stone clearance rate and recurrence rate between the two groups(P>0.05). The operation time, the time of getting out of bed after operation and the time of hospitalization in the observation group were significantly shorter than those in the control group, and the intraoperative bleeding volume was less than that in the control group(P<0.05). The levels of malondialdehyde(MDA) and cortisol(Cor) in the two groups at 3 d after operation and 7 d after operation were higher than those before operation, and increased first and then decreased(P<0.05). The level of superoxide dismutase(SOD) was lower than that before operation, and decreased first and then increased(P<0.05). The levels of MDA and Cor of the observation group at 3 d after operation and 7 d after operation were lower than those of the control group, and the SOD was higher than that of the control group(P<0.05). The levels of interleukin-2(IL-2), interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in the two groups at 3 d after operation and 7 d after operation were higher than those before operation, and increased first and then decreased(P<0.05). The levels of IL-2, IL-6 and TNF-α in the observation group at 3 d after operation and 7 d after operation were lower than those in the control group(P<0.05). The incidence of postoperative complications in the observation group was lower than that in the control group(P<0.05). Conclusion: Ureteroscopic holmium laser lithotripsy is safe and effective in the treatment of upper ureteral calculi. It can also improve clinical indicators and reduce oxidative stress and inflammatory stress.