腹腔镜肾盂切开取石术治疗复杂性肾结石的临床研究

Observation on postoperative complications of laparoscopic pyelolithotomy in patients with complex renal calculi and its effect on inflammatory response

目的探讨腹腔镜肾盂切开取石术治疗复杂性肾结石的临床疗效。方法选择中国人民解放军联勤保障部队第九一〇医院于2021年1月至2022年1月收治的复杂性肾结石患者96例,按随机数字表法分为研究组和对照组,每组48例。研究组行腹腔镜肾盂切开术,对照组行开放性肾切开取石术。观察并比较两组患者围术期指标、一次性结石清除及术后并发症情况、术前和术后3 d应激炎性反应指标[皮质醇(Cor)、IL-6、CRP]和肾功能[肌酐(Cr)、尿素氮(BUN)]变化。结果研究组患者术中出血量少于对照组,下床活动时间、手术时间和术后住院时间均短于对照组(均P<0.05)。两组患者一次性结石清除情况比较差异无统计学意义(P>0.05)。研究组术后并发症发生率低于对照组(P<0.05)。两组患者术后3 d血清Cor、IL-6和CRP水平均较术前升高(均P<0.05),但研究组均低于对照组(均P<0.05)。两组患者术后3 d Cr和BUN水平均较术前升高(均P<0.05),但研究组均低于对照组(均P<0.05)。结论腹腔镜肾盂切开取石术治疗复杂性肾结石效果明显,术后并发症发生率低,且对患者的应激炎性反应和肾功能影响小。

Objective To investigate the effect of laparoscopic pyelolithotomy on postoperative complications and corresponding inflammatory response in patients with complex renal calculi.Methods The 96 cases complex kidney stones in the Chinese People's Liberation Army 910 Hospital of the Joint Logistics Support Force from January 2021 to January 2022 randomly divided into study group(n=48)and control group(n=48).Study group treated laparoscopic pyelotomy,and control group treated open nephrolithotomy.The perioperative indexes,one-time stone clearance,postoperative complications,stress inflammatory response[cortisol(Cor),Interleukin 6(IL-6)and C-reactive protein(CRP)]and renal function[creatinine(Cr)and blood urea nitrogen(BUN)]changes before and 3 days after operation were recorded.Results The intraoperative blood loss of the study group was less than that of the control group,and the ambulation time,operation time and postoperative hospital stay of the study group were shorter than those of the control group(all P<0.05).There was no significant difference in one time stone clearance between the two groups(P>0.05).The incidence of postoperative complications in the study group was lower than that in the control group(P<0.05).The serum levels of Cor,IL 6,CRP,Cr and BUN in the two groups at 3 days after operation were higher than those before operation(all P<0.05),but the above indexes in the study group were lower than those in the control group(all P<0.05).Conclusion Laparoscopic pyeloli-thotomy is effective in the treatment complex renal calculi,with less postoperative complications and less impact on inflammatory response and renal function.