输尿管软镜碎石与经皮肾镜碎石对3cm以下肾结石疗效和炎性反应的影响

Effects of flexible ureteroscopy lithotripsy and percutaneous nephrolithotripsy on the efficacy and inflammatory response of renal calculi less than 3 cm

目的 分析输尿管软镜碎石术(FURS)和经皮肾镜碎石术(PCNL)治疗3 cm以下肾结石疗效,对比两种术式的有效性、可靠性以及对炎性反应的影响。方法 回顾2015年1月至2021年9月收治肾结石患者74例,分为FURS组(观察组)和PCNL组(对照组),其中FURS组35例,PCNL组39例。比较两组之间的手术前后各项指标。结果 FURS组在手术时间[(69.6±19.0)min vs(84.8±20.5)min,P<0.01]、住院时间[(3.8±1.1)d vs(6.4±1.3)d,P<0.01]、术中出血量[(21.4±8.9)mL vs(75.4±48.6)mL,P<0.01]、疼痛VAS评分(1.0±0.9 vs 3.2±1.6,P<0.01)、弗莱堡患者满意度(1.7±0.8 vs 2.2±1.1,P<0.05)、并发症(2.9%vs 17.9%,P<0.05)明显优于PCNL组。FURS组术后3 d的氧化应激指标皮质醇(Cor)[(209.3±20.9)ng/mL vs(226.4±38.8)ng/mL,P<0.05]、丙二醛(MDA)[(6.9±0.6)nmol/mL vs(10.0±1.0)nmol/mL,P<0.001]低于PCNL组,而超氧化物歧化酶(SOD)[(70.6±8.3)nu/mL vs(61.3±7.8)nu/mL,P<0.001]高于PCNL组。FURS组术后3 d的炎性因子白介素6(IL-6)[(11.8±1.1)pg/mL vs(14.1±1.1)pg/mL,P<0.001]、白介素10(IL-10)[(9.1±0.9)pg/mL vs(12.5±1.1)pg/mL,P<0.001]、肿瘤坏死因子α(TNF-α)[(1.7±0.1)ng/mL vs(2.3±0.1)ng/mL,P<0.001]低于PCNL组。结论 FURS能够安全有效的治疗3 cm以下肾结石同时降低术后氧化应激和炎性反应。

Objective To compare the effect of flexible ureteroscopy lithotripsy and percutaneous nephrolithotripsy in treatment of renal calculi less than 3 cm. The effectiveness, reliability and the effect on inflammatory response of the two methods were compared. Methods From January 2015 to September 2021, 74 patients with renal calculi were collected and divided into FURS group and PCNL group with 35 in FURS group and 39 in PCNL group. The indexes before and after operation were compared.Results The statistically significant difference was found in operation time [(69.6±19.0)min vs(84.8±20.5)min], hospitalization days [(3.8±1.1)d vs(6.4±1.3)], intraoperative bleeding[(21.4±8.9)mL vs(75.4±48.6)mL,P<0.01], pain VAS score [(1.0±0.9) vs(3.2±1.6),P<0.01],freiburg patients satisfaction [(1.7±0.8) vs(2.2±1.1),P<0.05] and complications(2.9% vs 17.9%,P<0.05). Three days after operation, the COR[(209.3±20.9)ng/mL vs(226.4±38.8)ng/mL P<0.05] and MDA [(6.9±0.6)nmol/mL vs(10.0±1.0)nmol/mL,P<0.01] in the FURS group were lower than those in the PCNL group, while SOD [(70.6±8.3)NU/mL vs(61.3±7.8)NU/m) was higher than those in the PCNL group and the difference was statistically significant. The IL-6[(11.8±1.1)pg/mL vs(14.1±1.1)pg/mL,P<0.001), IL-10 [(9.1±0.9)pg/mL vs(12.5±1.1)pg/mL,P<0.001] and TNF-α[(1.7±0.1)ng/mL vs(2.3±0.1)ng/mL,P<0.001]in the FURS group were significantly lower than those in the PCNL group three days after operation. Conclusions FURS is confirmed to be a safe and effective treatment for renal calculi less than 3 cm because of with low oxidative stress and inflammatory response.