经皮肾镜碎石术与输尿管软镜碎石术治疗输尿管上段结石的疗效比较及其对炎性因子的影响

The effect of percutaneous nephrolithotripsy and flexible ureteroscope lithotripsy in the treatment of upper ureteral calculi and its influence on inflammatory factors

目的对比经皮肾镜碎石术与输尿管软镜碎石术治疗输尿管上段结石的临床疗效,并观察两者对炎性因子表达水平的影响。方法选取2018年1月至2019年12月于本院就诊的70例输尿管上段结石患者,采用随机数字法将患者分为观察组和对照组,每组各35例。观察组采用输尿管软镜碎石术治疗,对照组采用经皮肾镜碎石术治疗。观察并记录两组患者的术中出血量、手术时间,术后复查并记录两组患者的住院时间、术后并发症、结石清除率。采集两组患者术前和术后第1、5天的外周血,采用酶联免疫吸附法(ELISA)试剂盒检测患者的C反应蛋白(CRP)、肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)的表达水平。结果观察组患者的术中出血量、术后住院时间和术后并发症发生率均显著低于对照组(均P<0.05),而手术时间和结石清除率均显著高于对照组(均P<0.05);观察组和对照组术后第1天的CRP、TNF-α和IL-6的表达水平均明显高于术前(均P<0.05);术后第1天,观察组的CRP、TNF-α和IL-6的表达水平均明显低于对照组(均P<0.05)。结论输尿管软镜碎石术治疗输尿管上段结石患者的疗效显著,可提高患者的结石清除率并降低术后炎性因子的表达水平,相较于经皮肾镜碎石术具有一定的临床优势。

Objective To compare the clinical effect of percutaneous nephrolithotripsy and flexible ureteroscope lithotripsy in the treatment of upper ureteral calculi,and to observe the influence of the two on the expression of inflammatory factors.Methods From January 2018 to December 2019,70 patients with upper ureteral calculi in our hospital were selected and randomly divided into observation group and control group,with 35 cases in each group.The observation group was treated with flexible ureteroscope lithotripsy and the control group was treated with percutaneous nephrolithotripsy.The amount of intraoperative bleeding and operation time were observed and recorded.The postoperative hospitalization time,postoperative complications and stone removal rate were reexamined and recorded.Peripheral blood was collected from two groups of patients before operation and on the 1st and 5th day after operation,and the expression levels of CRP,TNF-αand IL-6 were detected by ELISA kit.Results The bleeding volume,postoperative hospital stay and postoperative complication rate of the observation group were significantly lower than the control group,while the operation time and stone removal rate were significantly higher than the control group(all P<0.05).The expression levels of CRP,TNF-αand IL-6 on the fifth day after the observation group and the control group were significantly higher than before operation(all P<0.05).On the first day after surgery,the expression levels of CRP,TNF-αand IL-6 in the observation group were significantly lower than those in the control group(all P<0.05).Conclusions Flexible ureteroscope lithotripsy for the treatment of patients with upper ureteral calculi has a significant effect,which can improve the patient's stone clearance and reduce the expression levels of postoperative inflammatory factors.Compared with percutaneous nephrolithotripsy,it has certain clinical application advantages.