mPCNL与FURL联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响

Efficacy of the Combination of mPCNL and FURL in Treating Complete Cast Kidney Stones and Its Effect on the Patient’s Stress and Inflammatory Responses

目的探讨微通道经皮肾镜取石术(mPCNL)与输尿管软镜钬激光碎石术(FURL)联合治疗完全性铸型肾结石的效果及其对患者机体应激、炎症反应的影响。方法将104例完全性铸型肾结石患者随机分为对照组与研究组,每组52例。对照组行mPCNL治疗,研究组行mPCNL与FURL联合治疗。比较2组患者手术一般情况、结石清除率及并发症发生情况;观察2组术前术后肾功能[尿素氮(BUN)、肌酐(SCr)]、氧化应激[皮质醇(Cor)、丙二醛(MDA)、谷胱过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)]、炎症因子[白介素(IL)-6、C反应蛋白(CRP)、降钙素原(PCT)]指标的变化情况。结果与对照组相比,研究组手术时间、住院时间及结石清除率显著增加(P<0.05)。2组术前术后BUN、Scr水平比较差异无统计学意义(P>0.05)。与术前相比,2组术后24、48 h Cor、MDA水平显著升高(P<0.05),GSH-Px、SOD水平显著降低(P<0.05);与对照组术后各时点比较,研究组Cor、MDA水平显著降低(P<0.05),GSH-Px、SOD水平显著升高(P<0.05)。2组术后2 h IL-6水平均较术前显著升高(P<0.05),术后12 h IL-6水平与术前比较差异无统计学意义(P>0.05);研究组术后2 h IL-6水平显著低于对照组(P<0.05)。与术前相比,2组术后2、12 h PCT水平均显著升高(P<0.05);但研究组术后各时点PCT水平显著低于对照组(P<0.05)。与术前相比,2组术后24、48 h CRP水平显著升高;但研究组术后各时点CRP水平显著低于对照组(P<0.05)。结论mPCNL联合FURL治疗完全性铸型肾结石疗效确切,虽然延长了手术时间,但结石清除率显著增加,且不增加患者肾功能及机体应激与炎症反应程度,有利于术后恢复。

Objective To investigate the efficacy of the combination of microchannel percutaneous nephrolithotripsy(mPCNL)and flexible ureteral holmium laser lithotripsy(FURL)in the treatment of complete cast kidney stone and its effect on the patient’s stress and inflammatory responses.Methods 104 patients with complete cast kidney stones were randomly divided into control group and study group,52 cases in each group.The control group was treated with mPCNL,and the study group was treated with the combination of mPCNL and FURL.The general condition of operation,postoperative pain,renal function[blood urea nitrogen(BUN),serum creatinine(SCr)],oxidative stress[cortisol(Cor),Malondialdehyde(MDA),glutathione peroxidase(GSH Px),superoxide dismutase(SOD)],inflammatory factors[Interleukin 6(IL-6),C-reactive protein(CRP),and serum pro Calcitonin(PCT)]were compared between the two groups,and the stone clearance rate and complications were counted.Results Compared with the control group,the study group showed a significant increase in surgery time,hospitalization time and stone clearance rate(P<0.05).There was no significant difference in the levels of BUN and Scr between the two groups of patients before and after surgery(P>0.05).Compared with the preoperative period,the levels of Cor and MDA were significantly higher(P<0.05)and the levels of GSH-Px and SOD were significantly lower(P<0.05)in the 2 groups at 24 and 48 h postoperatively;compared with the control group at all time points postoperatively,the levels of Cor and MDA were significantly lower(P<0.05)and the levels of GSH-Px and SOD were significantly higher(P<0.05)in the study group.The 2 h postoperative IL-6 levels were significantly higher in both groups compared with the preoperative period(P<0.05),and the difference between the 12 h postoperative IL-6 levels and the preoperative period was not statistically significant(P>0.05);the 2 h postoperative IL-6 levels in the study group were significantly lower than those in the control group(P<0.05).Compared with the preoperative period,the 2 and 12 h postoperative PCT levels of the 2 groups were significantly higher(P<0.05);however,the PCT levels of the study group were significantly lower than those of the control group at all postoperative time points(P<0.05).Compared with the preoperative period,24 and 48 h postoperative CRP levels were significantly higher in the 2 groups;however,CRP levels at all postoperative time points were significantly lower in the study group than in the control group(P<0.05).Conclusion The combination of mPCNL and FURL might have positive therapeutic effects on complete cast kidney stones.Although it prolongs surgery time,the stone clearance rate may noticeably increase,without increasing the degree of stress and inflammatory responses on the patient’s renal function and body,which is beneficial for postoperative recovery.