微通道经皮肾镜取石手术对输尿管上段结石患者的应用效果及SIRS发生率的影响

Effect of Microchannel Percutaneous Nephrolithotomy on Patients with Upper Ureteral Calculi and Incidence of SIRS

目的研讨微通道经皮肾镜取石手术(Microchannel Percutaneous Nephrolithotomy,mPCNL)对输尿管上段结石患者的应用效果及全身炎症反应综合征(Systemic Inflammatory Response Syndrome,SIRS)发生率的影响。方法随机选取2019年8月-2022年12月厦门市中医院泌尿外科收治的100例输尿管上段结石患者为研究对象,按其入院时间顺序分组,对照组(50例)行输尿管镜钬激光碎石术(Ureteroscopic Holmium Laser Lithotripsy,URL),观察组(50例)行mPCNL术,对比两组手术基础指标、血流动力学、结石清除情况、SIRS以及术后狭窄发生情况。结果观察组手术时间较对照组长,差异有统计学意义(P<0.05);但其余手术基础指标两组对比较接近,差异无统计学意义(P均>0.05)。两组手术前后的血流动力学指标对比较接近,差异无统计学意义(P>0.05)。观察组一次性清石率(96.00%)高于对照组(82.00%),差异有统计学意义(χ^(2)=5.005,P<0.05);而SIRS以及术后狭窄发生率对比较接近,差异无统计学意义(P均>0.05)。结论mPCNL术用于输尿管上段结石的处理时间较长,但一次性清石率较高,对患者的血流动力学、术后恢复影响较小,且不增加术后SIRS及狭窄的发生风险。

Objective To investigate the effect of microchannel percutaneous nephrolithotomy(mPCNL)on upper ure-teral calculi and the incidence of systemic inflammatory response syndrome(SIRS).Methods A total of 100 patients with upper ureteral calculi admitted to the Department of Urinary Surgery of Xiamen Hospital of Traditional Chinese Medicine from August 2019 to December 2022 were randomly selected as the study objetcs,and were grouped accord-ing to the time order of admission.Control group(fifty cases)underwent ureteroscopic holmium laser lithotripsy(URL),observation group(fifty cases)underwent mPCNL.The basic indexes,hemodynamics,stone clearance,SIRS and post-operative stenosis were compared between the two groups.Results The operation time of the observation group was longer than that of the control group,and the difference was statistically significant(P<0.05).However,the other basic surgical indicators were similar between the two groups,and the differences were not statistically significant(all P>0.05).The hemodynamic index before and after operation was similar between the two groups,and there was no statis-tical significance(P>0.05).The one-time stone removal rate of observation group(96.00%)was higher than that of control group(82.00%),and the difference was statistically significant(χ^(2)=5.005,P<0.05).The incidence of SIRS and postoperative stenosis were similar,and there was no statistical significance(both P>0.05).Conclusion mPCNL has a longer treatment time for upper ureteral calculi,but the one-time stone removal rate is higher,which has little impact on the hemodynamics and postoperative recovery of patients,and does not increase the occurrence of postoperative SIRS and stenosis.