FURSL与MPCNL治疗直径>2 cm上尿路结石的疗效及炎性反应对比探究  

Comparative study of curative effect and inflammatory response between FURSL and MPCNL in the treament of > 2 cm upper urinary tract calculus

作　　者：邢增术 李东辉[1] 黄义[1] 刘振湘[1] 白志明[1] XING Zeng-shu;LI Dong-hui;HUANG Yi;LIU Zhen-xiang;BAI Zhi-ming(Department of Urology,Haikou Hospital A？liated to Xiangya School of Medicine,Central South University,Haikou 570208,China)

机构地区：[1]中南大学湘雅医学院附属海口医院泌尿外科,海口570208

出　　处：《中国医学前沿杂志（电子版）》2018年第9期128-132,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

摘　　要：目的比较输尿管软镜钬激光碎石取石术(flexible ureteroscope lithotripsy,FURSL)与微创经皮肾镜取石术(minimally-invasive percutaneous nephrolithotomy,MPCNL)治疗直径>2 cm上尿路结石的疗效及炎性反应。方法回顾性分析2016年1月至2018年2月本院收治的122例直径>2 cm单侧上尿路结石患者的基线资料和围术期资料,根据手术方式将其分为FURSL组(71例)和MPCNL组(51例)。比较两组患者的基线资料与围术期资料,分别于术前、术后第1天和第4天,检测并比较两组患者血清超敏C反应蛋白(hypersensitive C reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、γ-干扰素(interferon-γ,IFN-γ)、白介素-6(interleukin-6,IL-6)等炎性因子的水平。结果FURSL组患者的手术时间显著长于MPCNL组(P<0.05),术后平均住院天数显著短于MPCNL组(P<0.05),血红蛋白降低值、术后第2天结石清除率均显著低于MPCNL组(P_均<0.05)。两组患者手术一次成功率、术后并发症发生率、术后第3周结石清除率比较差异均无显著性(P_均>0.05)。术后第1天和第4天,两组患者hs-CRP、TNF-α、IL-6水平均显著高于术前(P_均<0.05),INF-γ水平均显著低于术前(P_均<0.05);FURSL组患者hs-CRP、TNF-α、IL-6水平均显著低于MPCNL组同期水平(P_均<0.05),IFN-γ水平均显著高于MPCNL组同期水平(P_均<0.05)。结论 FURSL和MPCNL均为直径>2 cm上尿路结石安全、有效的治疗方法,二者疗效相当。与MPCNL相比,采用FURSL治疗的患者术后恢复更快,炎性反应更轻,免疫功能变化更小。ObjectiveTo compare the curative effect and inffammatory response between ffexible ureteroscope lithotripsy （FURSL） and minimally-invasive percutaneous nephrolithotomy （MPCNL） in the treament of 〉 2 cm upper urinary tract calculus. MethodRetrospectively analyzed the baseline and perioperative data of 122 cases of upper urinary tract calculus with diameter 〉 2 cm admitted to our hospital from January 2016 to February 2018. The patients were divided into FURSL group （71 cases） and MPCNL group （51 cases） according to the operative method. The baseline data and perioperative data of the two groups were compared. The serum levels of hypersensitive C reactive protein （hs-CRP）, tumor necrosis factor-α （TNF-α）, interferon-γ （IFN-γ）, interleukin-6 （IL-6） were detected and compared before operation, on the 1st and 4th day after operation between the two groups. ResultThe operation time of FURSL group was signiffcantly longer than that of MPCNL group （P〈0.05）, the average hospitalization days were signiffcantly shorter than that of MPCNL group （P〈 0.05）, the decrease of hemoglobin and the stone clearance rate on the 2nd day after operation were signiffcantly lower than that of MPCNL group （Pall〈0.05）. There were no signiffcant differences in the primary success rate, postoperative complication rate and stone clearance rate at the3rd weekend between the two groups （Pall〉 0.05）. On the 1st and 4th day after operation, the levels of hs-CRP, TNF-α and IL-6 in both groups were signiffcantly higher than those before operation （Pall〈 0.05）, and the levels of IFN-γ were signiffcantly lower than those before operation （Pall〈 0.05）; the levels of hs-CRP, TNF-α and IL-6 in FURSL group were signiffcantly lower than those in MPCNL group （Pall〈0.05）, and the levels of IFN-γ were signiffcantly higher than those in MPCNL group （Pall〈 0.05）. ConclusionBoth FURSL and MPCNL are safe and effectivein the treatment of 〉2 cm upper urinary tract calculus,

关 键 词：上尿路结石 输尿管软镜碎石术 微创经皮肾镜取石术 炎性因子 

分 类 号：R699[医药卫生—泌尿科学]