三种微创术式治疗对嵌顿性输尿管上段结石患者肾功能、血清CAT、GSH-Px、MDA、ROS水平及炎症因子水平的影响

Effect of three kinds of minimally invasive surgeries on the renal function,serum CAT, GSH-Px, MDA and ROS levels and inflammatory factors in patients with impacted upper ureteral calculi

目的:分析经尿道输尿管镜碎石术(URL)、微创经皮肾镜取石术(MPCNL)、腹膜后腹腔镜输尿管切开取石术(RLU)三种微创术式治疗对嵌顿性输尿管上段结石患者肾功能、氧化应激、炎症因子水平的影响。方法:选取2014年3月-2017年3月收治的嵌顿性输尿管上段结石患者120例,依据手术方法将其分为URL组(50例)、MPCNL组(40例)、RLU组(30例),比较三组结石清除率、手术一般情况及手术前后肾功能[血尿素氮(BUN)、血肌酐(SCr)、明胶酶相关脂质运载蛋白(NGAL)]、氧化应激[过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)、丙二醛(MDA)、活性氧(ROS)]与炎症因子[肿瘤坏死因子-α(TNF-α)、C反应蛋白(CRP)]水平、并发症发生情况。结果:URL组结石清除率、手术时间、住院时间低/短于MPCNL组、RLU组,MPCNL组手术时间短于RLU组,住院时间长于RLU组(P<0.05);URL组术后3 d NGAL高于MPCNL组、RLU组(P<0.05),三组BUN、SCr比较差异无统计学意义(P>0.05);术后24 h三组CAT、GSH-Px均下降,而MDA、ROS、TNF-α、CRP水平均增加,且URL组术后GSH-Px高于MPCNL组、RLU组,而MDA、CRP低于MPCNL组、RLU组(P<0.05);Pearson相关性分析发现,三组术后CAT、GSH-Px与TNF-α、CRP均呈负相关,而MDA、ROS与TNF-α、CRP均呈正相关(P<0.05);三组术后并发症发生率比较差异无统计学意义(P>0.05)。结论:URL、MPCNL、RLU三种微创术式治疗嵌顿性输尿管上段结石疗效均可靠,各有优势,临床应根据患者情况进行选择。

Objective:To analyze the effect of transurethral ureteroscopic lithotripsy(URL),minimally invasive percutaneous nephrolithotomy(MPCNL)and retroperitoneal laparoscopic ureterolithotomy(RLU)on the renal function,oxidative stress and levels of inflammatory factors in patients with impacted upper ureteral calculi.Methods:120 patients with impacted upper ureteral calculi who were admitted to our hospital from March 2014 to March 2017 were divided into URL group(50 cases),MPCNL group(40 cases)and RLU group(30 cases)according to the different surgical procedures.The three groups were treated by URL,MPCNL and RLU,respectively.The stone clearance rate,general situation of surgery and renal function[blood urea nitrogen(BUN),serum creatinine(SCr),neutrophil gelatinase associated lipocalin(NGAL)],oxidative stress[catalase(CAT),glutathione peroxidase(GSH-Px),malonaldehyde(MDA),reactive oxygen species(ROS)],inflammatory cytokines[tumor necrosis factor alpha(TNF-α),C reactive protein(CRP)]and complications were compared among three groups.Results:The stone clearance rate was lower,and operative time and length of hospital stay were shorter in URL group than those in MPCNL group and RLU group.The operative time was shorter,but the length of hospital stay was longer in MPCNL group than those in RLU group(P<0.05).The NGAL in URL group at 3 rd day after operation was higher in URL group than in MPCNL group and RLU group(P<0.05),but there was no significant difference in BUN or SCr among the three groups(P>0.05).Levels of CAT and GSH-Px decreased,while levels of MDA,ROS,TNF-αand CRP increased in the three groups at 24 h after surgery.After surgery,GSH-Px was higher while MDA and CRP were lower in URL group than in MPCNL group and RLU group(P<0.05).Pearson correlation analysis found that CAT and GSH-Px were negatively correlated with TNF-αand CRP in the three groups,while MDA and ROS were positively correlated with TNF-αand CRP(P<0.05).There was no significant difference in the incidence of postoperative complications among the three groups(P>0.05).Conclusions:URL,MPCNL and RLU are effective and reliable in the treatment of impacted upper ureteral calculi.All of the three kinds of minimally invasive surgeries have their advantages,therefore,the surgery should be chosen according to the condition of patients.