四妙散加味联合后腹腔镜输尿管切开取石术治疗输尿管上段嵌顿性结石合并肾积脓的临床效果

Clinical effect of modified Simiao Powder combined with retroperitoneoscopic ureterolithotomy in the treatment of upper ureteral incarcerated calculi with empyema

目的探讨输尿管上段嵌顿性结石合并肾积脓采用后腹腔镜输尿管切开取石术(RPUL)与四妙散加味联合治疗的效果。方法回顾性分析2016年1月~2020年4月江西省中西医结合医院收治的80例输尿管上段嵌顿性结石合并肾积脓患者的临床资料,根据治疗方式的不同将其分为A组(四妙散加味+RPUL治疗,28例)、B组(排石颗粒+RPUL治疗,26例)和C组(RPUL治疗,26例)。比较三组患者术后1周血清降钙素原(PCT)、尿白细胞(U-WBC)和红细胞计数(RBC)水平及术后体温超过38.5℃的天数、拔管时间、视觉模拟评分法(VAS)评分。结果A组患者术后1周的血清PCT、U-WBC及RBC水平均低于B组、C组,且B组患者的血清PCT、U-WBC及RBC均水平低于C组,差异有统计学意义(P<0.05);A组患者术后体温超过38.5℃的天数、拔管时间短于B组、C组,VAS评分均低于B组、C组,且B组患者术后体温超过38.5℃的天数、拔管时间短于C组,VAS评分低于C组,差异有统计学意义(P<0.05)。结论输尿管上段嵌顿性结石合并肾积脓采用RPUL与四妙散加味联合治疗的效果更佳,可以有效降低血清PCT、U-WBC及RBC水平,减轻患者疼痛感。

Objective To explore the effect of retroperitoneoscopic ureterolithotomy(RPUL)combined with modified Simiao Powder in the treatment of upper ureteral incarcerated calculi with empyema.Methods The clinical data of 80 patients with upper ureteral incarcerated calculi and empyema in Jiangxi Hospital of Integrated Traditional Chinese and Western Medicine from January 2016 to April 2020 were retrospectively analyzed and they were divided into group A(modified Simiao Powder+RPUL treatment,28 cases),group B(Paishi Granules+RPUL treatment,26 cases)and group C(RPUL treatment,26 cases)according to different treatment methods.The levels of serum procalcitonin(PCT),urinary white blood cell(U-WBC)and red blood cell count(RBC)at 1 week after surgery,the number of days of body temperature over 38.5℃ after surgery,extubation time and visual analogue scale(VAS)score of the three groups were compared.Results The serum PCT,U-WBC and RBC levels of group A at 1 week after surgery were lower than those of group B and C,and the serum PCT,U-WBC and RBC levels of group B were lower than those of group C,the differences were statistically significant(P<0.05).The number of days of body temperature over 38.5℃ after surgery and the extubation time in group A were shorter than those in group B and C,and the VAS score was lower than that in group B and C;and the number of days of body temperature over 38.5℃ and the extubation time in group B were shorter than those in group C,and the VAS score was lower than that in group C,the differences were statistically significant(P<0.05).Conclusion The RPUL combined with modified Simiao Powder in the treatment of upper ureteral incarcerated calculi with empyema has better effect,which can effectively reduce serum PCT,U-WBC and RBC levels,and relieve pain of patients.