微创经皮肾镜取石术治疗输尿管上段结石合并感染患者对结石清除率、肾功能及炎性因子的影响分析

Effects of Mini-percutaneous Nephrolithotomy on Stone Clearance,Renal Function and Inflammatory Factors in Treatment of Patients with Upper Ureteral Calculi Combined with Infection

目的探讨微创经尿道输尿管镜取石(URL)术与微创经皮肾镜取石(MPCNL)术治疗输尿管上段结石合并感染患者对结石清除率、肾功能及炎性因子影响。方法选取2017年11月—2020年11月我院收治的上尿路结石合并感染的患者102例为研究对象,按手术方式不同分为观察组和对照组,每组51例。对照组给予URL治疗,观察组给予MPCNL治疗。比较2组的手术指标、结石清除率和术后并发症发生情况。分析2组手术前后肝、肾功能及炎性因子水平变化情况。结果2组手术时间、术中出血量、住院时间比较差异无统计学意义(P>0.05);观察组结石清除率高于对照组(P<0.05)。2组术前、术后组间及组内肾功能指标(血肌酐、尿素、尿酸)及肝功能指标(丙氨酸氨基转移酶、天冬氨酸氨基转移酶、白蛋白、总胆红素)比较差异均无统计学意义(P>0.05)。与术前比较,2组术后白细胞介素-8(IL-8)、IL-6、肿瘤坏死因子-α水平降低,IL-4水平升高,且观察组上述指标变化更显著,差异有统计学意义(P<0.05)。观察组术后并发症总发生率低于对照组(P<0.05)。结论MPCNL术治疗输尿管上段结石合并感染结石清除率高,有利于改善患者的炎症反应,且该手术方法安全可靠。

Objective To explore effects of minimally invasive ureteroscopic lithotripsy(URL)and mini-percutaneous nephrolithotomy(MPCNL)on stone clearance,renal function and inflammatory factors in treatment of patients with upper ureteral calculi combined with infection.Methods A total of 102 patients with upper ureteral calculi combined with infection admitted during November 2017 and November 2020 were enrolled,and the patients were divided into observation group(n=51)and control group(n=51)according to different surgical methods.Control group was given URL,while observation group was given MPCNL.Surgical indicators,stone clearance rates and incidence rates of postoperative complications were compared,and changes in liver and kidney functions and levels of inflammatory factors before and after the surgery were analyzed in two groups.Results There were no significant differences in surgical duration,intraoperative volume of blood loss and length of hospitalization between two groups(P>0.05).Stone clearance rate in observation group was significantly higher than that in control group(P<0.05).There were no significant differences in renal function indexes[serum creatinine(SCr),blood urea nitrogen(BUN),uric acid(UA)]and liver function indexes(alanine aminotransferase,aspartate aminotransferase,albumin,total bilirubin)before and after surgery between inter-or intra-groups(P>0.05).After surgery,levels of interleukin(IL)-8,IL-6 and tumor necrosis factor-α(TNF-α)were significantly decreased,while IL-4 levels were significantly increased compared with those before treatment in two groups,and the changes of above indicators in observation group were more significant than those in control group(P<0.05).The total incidence rate of postoperative complications in observation group was significantly lower than that in control group(P<0.05).Conclusion MPCNL in treatment of patients with upper ureteral calculi and infection may achieve better stone clearance rate,and it is beneficial to improve inflammatory response with safe.