无管化微创经皮肾镜取石术治疗≥1 cm嵌顿性输尿管上段结石的效果及对隐性失血量、应激反应指标的影响

Effect of tubeless minimally invasive percutaneous nephrolithotomy on≥1 cm incarcerated upper ureteral stones and its influences on hidden blood loss and stress response indexes

目的探讨无管化微创经皮肾镜取石术治疗≥1 cm嵌顿性输尿管上段结石的效果。方法选取2018年6月至2021年6月我科收治的100例≥1 cm嵌顿性输尿管上段结石患者,以双盲法随机分为对照组和观察组,各50例。对照组采用常规后腹腔镜手术,观察组采用无管化微创经皮肾镜取石术。比较两组的治疗效果。结果两组的结石清除率、并发症总发生率无明显差异(P>0.05)。观察组的隐性失血量少于对照组,术后1、3、5 d的血红蛋白(Hb)水平高于对照组(P<0.05)。术后1 d,观察组的皮质醇(Cor)、肾上腺素(E)及前列腺素E_(2)(PGE_(2))水平低于对照组(P<0.05)。术后1 d,观察组的细胞间黏附分子-1(ICAM-1)、髓过氧化物酶(MPO)水平低于对照组(P<0.05)。结论无管化微创经皮肾镜取石术治疗≥1 cm嵌顿性输尿管上段结石有助于减少隐性失血量,减轻应激反应,值得推广。

Objective To explore the effect of tubeless minimally invasive percutaneous nephrolithotomy on≥1 cm incarcerated upper ureteral stones.Methods A total of 100 patients with≥1 cm incarcerated upper ureteral stones admitted in our department from June 2018 to June 2021 were selected and randomly divided into control group and observation group by double blind method,with 50 cases in each group.The control group underwent routine retroperitoneal laparoscopic surgery,while the observation group underwent tubeless minimally invasive percutaneous nephrolithotomy.The treatment effects of the two groups were compared.Results There were no significant differences in stone clearance rate and total incidence of complications between the two groups(P>0.05).The hidden blood loss of the observation group was less than that of the control group,and the hemoglobin(Hb)level at 1,3 and 5 d after operation was higher than that of the control group(P<0.05).At 1 d after operation,the levels of cortisol(Cor),epinephrine(E)and prostaglandin E_(2)(PGE_(2))in the observation group were lower than those in the control group(P<0.05).At 1 d after operation,the levels of intercellular adhesion molecule-1(ICAM-1)and myeloperoxidase(MPO)in the observation group were lower than those in the control group(P<0.05).Conclusion Tubeless minimally invasive percutaneous nephrolithotomy on≥1 cm incarcerated upper ureteral stones is helpful to reduce hidden blood loss and stress response,which is worthy of promotion.