ESWL与mPCNL治疗上尿路结石的疗效、应激反应及血流动力学对比研究

Comparative study of effect,stress response and hemodynamics of ESWL and MPCNL in treating upper urinary tract calculi

目的比较体外冲击波碎石术(ESWL)与微创经皮肾镜取石术(mPCNL)治疗上尿路结石的疗效及对应激反应、血流动力学的影响。方法选择该院2017年11月至2019年10月收治的200例上尿路结石患者为研究对象,根据不同治疗方法分为ESWL组和mPCNL组,各100例。比较两组结石清除成功率、手术时间、住院时间及治疗费用,以及术前及术后血清内皮素-1(ET-1)、血红素氧合酶-1(HO-1)、皮质醇(COR)及促血管生成素-Ⅱ(Ang-Ⅱ)变化,术前及术后心率(HR)、中心静脉压(CVP)、平均动脉压(MAP)变化。结果mPCNL组结石清除成功率(98.00%)高于ESWL组(88.00%),手术时间、住院时间及治疗费用均长于或高于ESWL组(P<0.05);两组术前ET-1、HO-1、COR、Ang-Ⅱ、HR、CVP、MAP比较,差异均无统计学意义(P>0.05);两组术后ET-1、HO-1、COR、Ang-Ⅱ、CVP、MAP均升高(P<0.001),且mPCNL组术后ET-1、HO-1、COR、Ang-Ⅱ均高于ESWL组(P<0.001);两组术后HR、CVP、MAP比较差异无统计学意义(P>0.05);ESWL组并发症发生率(2.00%)明显低于mPCNL组(13.00%),差异有统计学意义(P<0.05)。结论ESWL与mPCNL治疗上尿路结石的疗效各具优势,临床医生在选择治疗手段时,应综合考虑结石位置、大小及患者需求等各种因素,进而选择最佳术式进行治疗。

Objective To compare the effect of extracorporeal shock wave lithotripsy(ESWL)and minimally invasive percutaneous nephrolithotomy(mPCNL)in the treatment of upper urinary tract calculi and their effect on the stress response and hemodynamics.Methods Two hundreds patients with upper urinary tract calculi admitted in this hospital from November 2017 to October 2019 were selected as the study subjects and divided into the ESWL group and MPCNL group according to different treatment methods,100 cases in each group.The success rate of stone removal,operation time,hospitalization time and treatment cost,changes of serum ET-1,HO-1,COR and Ang-Ⅱ,HR,CVP and MAP before and after operation were compared between the two groups.Results The success rate of stone removal in the MPCNL group was 98.00%,which was higher than 88.00%in the ESWL group,the operation time,hospitalization time and treatment cost were longer or higher than those in the ESWL group(P<0.05);there was no statistically significant difference in ET-1,HO-1,COR,Ang-Ⅱ,HR,CVP and MAP before operation between the two groups(P>0.05);ET-1,HO-1,cor,Ang-Ⅱ,CVP and MAP after operation were all increased in both groups(P<0.001),moreover ET-1,HO-1,COR and Ang-Ⅱin the mPCNL group were all higher than those in the ESWL group(P<0.05)There was no statistically significant difference in HR,CVP and MAP after operation between the two groups(P>0.05).The incidence rate of complications in the ESWL group was 2.00%,which was lower than 26.00%in the mPCNL group,and the difference was statistically significant(P<0.05).Conclusion ESWL and MPCNL have their own advantages in the treatment of upper urinary tract calculi.When the clinicians choose the treatment method,should comprehensively consider the calculi location,size and patients′needs,and then choose the best operation mode.