mPNL、SPCNL及FURL治疗2~3 cm肾结石临床效果比较及对免疫功能与应激反应的影响

Comparison of Clinical Efficacy of MPNL,SPCNL and FURL in the Treat⁃ment of 2-3 cm Kidney Stones and Their Effects on Immune Function and Stress Response

目的探讨应用微通道经皮肾镜取石术(Micro-channel Percutaneous Nephrolithotomy,mPNL)、标准通道经皮肾镜取石术(Standard Channel Percutaneous Nephrolithotomy,SPCNL)、输尿管软镜碎石取石术(Flexible Ureteral Lithotripsy,FURL)3种不同方式治疗2~3 cm肾结石效果及对免疫功能、应激反应影响。方法选择2022年9月—2023年9月南京市江宁医院收治的120例肾结石者为研究对象,根据手术方式分成甲组(mPNL)、乙组(SPCNL)、丙组(FURL),各40例。比较3组患者一期结石清除率、手术前后免疫功能、应激反应及术后并发症发生情况。结果3组患者一期结石清除率比较,差异无统计学意义(P>0.05)。术后3 d各组患者CD4+、CD4+/CD8+比值较术前降低,且丙组均高于甲、乙两组;术后3 d各组患者CD8+较术前升高,且丙组低于甲、乙两组,差异有统计学意义(P均<0.05)。术中3组的血管紧张素I、去甲肾上腺素水平较术前升高,术后较术中下降;而丙组术中、术后的血管紧张素I、去甲肾上腺素水平均低于甲、乙两组,差异有统计学意义(P均<0.05)。丙组并发症总发生率最低,但3组对比差异无统计学意义(P>0.05)。结论相对比mPNL、SPCNL,采取FURL治疗肾结石效果更好,可减轻对机体免疫功能及应激反应影响,术后并发症较少。

Objective To investigate the effect of micro-channel percutaneous nephrolithotomy(mPNL),standard channel percutaneous nephrolithotomy(SPCNL)and flexible ureteral lithotripsy(FURL)in the treatment of 2-3 cm kidney stones and their effects on immune function and stress response.Methods A total of 120 patients with kidney stones admitted to Nanjing Jiangning Hospital from September 2022 to September 2023 were selected as the study ob⁃jects and divided into group A(mPNL),Group B(SPCNL)and group C(FURL)according to surgical methods,with 40 cases each.The primary stone clearance rate,immune function before and after operation,stress response and postop⁃erative complications were compared in the 3 groups.Results There was no significant difference in the first-stage stone clearance among 3 groups(P>0.05).The ratio of CD4+and CD4+/CD8+in group C was higher than that in group A and group B at 3 days after operation.CD8+in all groups was higher than before 3 days after surgery,and group C was lower than group A and group B,the differences were statistically significant(all P<0.05).The levels of angioten⁃sin and norepinephrine in 3 groups were higher than those before operation,but decreased after operation.The levels of angiotensin and norepinephrine in group C were lower than those in group A and group B,and the differences were statistically significant(both P<0.05).The total incidence of complications in group C was the lowest,but there was no significant difference among the three groups(P>0.05).Conclusion Compared with mPNL and SPCNL,FURL is more effective in the treatment of kidney stones,which can reduce the influence on immune function and stress response,and has fewer postoperative complications.