输尿管软镜钬激光碎石治疗输尿管上段结石临床观察及对应激反应和炎症因子水平的影响

Clinical Observation of Flexible Ureteroscopic Holmium Laser Lithotripsy in the Treatment of Upper Ureteral Calculi and Its Influence on Stress Response and Inflammatory Factors

目的:探讨输尿管软镜钬激光碎石治疗输尿管上段结石效果及对应激反应和炎症因子水平影响。方法:选择2019年1月-2020年6月笔者所在医院输尿管上段结石120例,根据不同手术方法分为观察组60例与对照组60例。观察组患者行输尿管软镜钬激光碎石术治疗,对照组患者行微通道经皮肾镜钬激光碎石术治疗。比较两组围术期指标变化,术后并发症发生情况,术后3、12 h和24 h疼痛视觉模拟评分(VAS),术前、术后1 d和术后5 d应激反应[皮质醇(Cor)和去甲肾上腺素(NE)]和炎症因子[C反应蛋白(CRP)和肿瘤坏死因子-α(TNF-α)]变化。结果:观察组输尿管上段结石患者术中出血量少于对照组(P<0.05);而两组手术耗时差异无统计学意义(P>0.05)。两组术后并发症比较差异无统计学意义(P>0.05)。观察组术后3、12 h和24 h患者VAS评分低于对照组(P<0.05)。观察组术后1 d和术后5 d血清Cor和NE水平低于对照组(P<0.05)。观察组术后1 d和术后5 d血清CRP和IL-6水平低于对照组(P<0.05)。结论:输尿管软镜钬激光碎石治疗输尿管上段结石,术中出血量小,术后并发症少,对术后应激反应和炎症反应影响小。

Objective:To investigate the clinical observation of flexible ureteroscopic holmium laser lithotripsy in the treatment of upper ureteral calculi and its influence on stress response and inflammatory factors.Method:A total of 120 cases of upper ureteral calculi in our hospital from January 2019 to June 2020 were selected and divided into observation group (60 cases) and control group (60 cases) according to different surgical methods.The observation group was treated with flexible ureteroscopy holmium laser lithotripsy,while the control group was treated with micro channel percutaneous nephrolithotomy.The changes of perioperative indexes,postoperative complications,VAS at 3,12 h and 24 h after operation,stress response[cortisol (Cor) and norepinephrine (NE)]and inflammatory factors[C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α)]were compared between the two groups before operation,1 day and 5 days after operation.Result:The intraoperative blood loss of observation group was less than that of control group (P<0.05),but no significant difference in operation time between the two groups (P>0.05).There was no significant difference in postoperative complications between the two groups (P>0.05).The VAS score of observation group was lower than that of control group at 3,12 h and 24 h after operation (P<0.05).The levels of serum Cor and NE in the observation group were lower than those in the control group on 1 day and 5 days after operation (P<0.05).The levels of serum CRP and IL-6 in the observation group were lower than those in the control group at 1 day and 5 days after operation (P<0.05).Conclusion:Flexible ureteroscopic holmium laser lithotripsy has little hemorrhage during operation,less postoperative complications and less impact on postoperative stress response and inflammatory response.