微创经皮肾镜取石术治疗输尿管上段结石的效果及其对氧化应激、血清炎症因子的影响

Effect of Mini-percutaneous Nephrolithotomy on Upper Ureteral Calculi and Its Effects on Oxidative Stress and Serum Inflammatory Factors

目的探讨微创经皮肾镜取石术(MPCNL)治疗输尿管结石的临床效果及其对患者氧化应激、血清炎症因子的影响。方法选取2015年6月至2017年9月在河南科技大学第一附属医院新区医院接受手术治疗的120例输尿管上段结石患者进行回顾性分析,根据手术方法分为MPCNL组(60例)和输尿管镜气压弹道碎石取石术(URL)组(60例),对比两组的手术时间、出血量、术后住院时间、碎石成功率、结石排尽率,比较手术前后两组患者血清皮质醇(Cor)、丙二醛(MDA)、超氧化物歧化酶(SOD)、白细胞介素-2(IL-2)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果MPCNL组的手术时间、术后住院时间长于URL组,出血量大于URL组(P<0.05),MPCNL组的碎石成功率、结石排尽率均高于URL组(P<0.05)。术后24h,MPCNL组的血清Cor、MDA水平高于URL组(P<0.05),SOD水平低于URL组(P<0.05),MPCNL组IL-2、IL-6、TNF-α水平高于URL组(P<0.05)。MPCNL组的手术并发症发生率(16.67%)高于URL组(5.00%)(P<0.05)。结论与URL比较,MPCNL治疗上段输尿管结石的碎石效果及结石排出效果更好,但是患者的氧化应激反应、炎症反应及手术并发症发生率较高。

Objective To investigate the clinical effect of mini-percutaneous nephrolithotomy(MPCNL)in the treatment of upper ureteral calculi and its effects on oxidative stress and serum inflammatory factors.Methods A total of 120 patients with upper ureteral calculi who underwent surgery in New District Hospital of the First Affiliated Hospital of Henan University of Science and Technology from June 2015 to September 2017 were retrospectively analyzed.According to the surgical methods,they were divided into MPCNL group(60 cases)and ureteroscopic pneumatic lithotripsy(URL)group(60 cases).The operation time,blood loss,postoperative hospital stay,lithotripsy success rate and stone excretion rate of the two groups were compared.The levels of serum cortisol(Cor),malondialdehyde(MDA),superoxide dismutase(SOD),interleukin-2(IL-2),IL-6 and tumor necrosis factor-a(TNF-a)were compared before and after operation.Results The operation time and postoperative hospital stay in MPCNL group were longer than those in URL group,the amount of bleeding was greater than that in URL group(P<0.05).The success rates of lithotripsy and stone excretion in MPCNL group were higher than those in URL group(P<0.05).24 hours after operation,the levels of serum Cor and MDA in MPCNL group were higher than those in URL group(P<0.05),and the level of SOD was lower than that in URL group(P<0.05),the levels ofIL-2,IL-6 and TNF-a in MPCNL group were higher than those in URL group(P<0.05).The incidence of surgical complications(16.67%)in MPCNL group was higher than that(5.00%)in URL group(P<0.05).Conclusion Compared with URL,MPCNL has better lithotripsy effect and stone excretion effect in the treatment of upper ureteral calculi,but the incidence rates of oxidative stress reaction,inflammatory reaction and surgical complications are higher.