输尿管软镜钬激光碎石治疗输尿管上段结石对机体免疫应激的影响  

Flexible Ureteroscope-Holmium Laser Lithotripsy for the Treatment of Upper Ureteral Calculi: Effect on Immune and Stress Response

作　　者：张河元[1] 黄裕清[1] 吴国忠[1] 姚史武[1] 邓汪东[1] 黄敏志[1] 钟伟枫[2] 陈洁[3] 

机构地区：[1]梅州市人民医院泌尿外二科,广东梅州514000 [2]中山大学肿瘤防治中心泌尿外科,广东广州510060 [3]暨南大学附属第一医院泌尿外科,广东广州510630

出　　处：《临床医学工程》2017年第6期767-769,共3页Clinical Medicine & Engineering

基　　金：梅州市科技计划项目(项目编号:2013B07)

摘　　要：目的观察输尿管软镜钬激光碎石术治疗L2~L3水平的输尿管上段结石对患者免疫应激功能的影响。方法将60例输尿管上段结石患者随机分为输尿管软镜碎石组和微创经皮肾镜碎石组,检测术前和术后的血WBC、血清IL-6、IL-10、CRP、IgG、IgA、IgM、CD4^+、CD8^+及CD4^+/CD8^+水平,并比较两组的手术时间、结石清除率、住院时间。结果所有患者均成功完成手术。输尿管软镜碎石组的手术时间、血红蛋白下降值、住院时间均显著低于微创经皮肾镜碎石组,差异有统计学意义(P<0.05)。两组患者术后第1 d的WBC、IL-6、IL-10、CRP水平均高于术前,IgG、IgA、IgM、CD4^+、CD8^+及CD4^+/CD8^+水平均显著低于术前,差异具有统计学意义(P<0.05);术后第5 d,两组的以上指标与术前比较均无统计学差异(P>0.05)。术后第3 d,输尿管软镜碎石组的IL-6、IL-10、CRP水平显著低于微创经皮肾镜碎石组(P<0.05)。结论输尿管软镜钬激光碎石术治疗输尿管上段结石对患者机体免疫应激功能影响小,具有快速康复、创伤小等优点。Objective To observe the effect on the immune and stress response of flexible ureteroscope-holmium laser lithotripsy for the treatment of upper ureteral calculi at L2 - L3 level. Methods 60 cases of patients with upper ureteral calculi were randomly divided into the flexible ureteroscope lithotripsy group and minimally invasive percutaneous neplrolithotripsy group. Before and after surgery, the levels of WBC, IL-6, IL-10, CRP, IgG, IgA, IgM, CD4＋, CD8＋ and CD4＋/CD8＋ were detected, and the operation time, stone clearance rate and hospitalization time were compared between two groups. Results All patients completed the operation successfully. The operation time, decreased hemoglobin value and hospitalization time of flexible ureteroscope lithotripsy group were significantly lower than those of minimally invasive percutaneous neplrolithotripsy group （P 〈0.05）. 1 day after surgery, both groups had significantly increased levels of WBC, IL-6, IL-10 and CRP, and significantly decreased levels of IgG, IgA, IgM, CD4＋, CD8＋ and CD4＋/CD8＋ （P〈0.05）; 5 days after surgery, all the indicators of both groups returned to the levels before surgery （P〉0.05）. 3 days after surgery, the levels of IL-6, IL-10 and CRP of flexible ureteroscope lithotripsy group were significantly lower than those of minimally invasive percutaneous neplrolithotripsy group （P〈0.05）. Conclusions Flexible ureteroscope-holmium laser lithotripsy for the treatment of upper ureteral calculi has little effect on the immune and stress response of patients, and has the advantages of fast recovery and small trauma.

关 键 词：输尿管软镜 钬激光碎石 免疫 应激反应 输尿管上段结石 

分 类 号：R693.4[医药卫生—泌尿科学]