软性输尿管镜同期治疗双侧上尿路结石对全身应激反应及外周血T细胞亚群的影响研究  

Influence on systemic stress response and peripheral blood T lymphocyte subsets after simultaneous flexible ureteroscopic lithotripsy of bilateral upper urinary tract stones

作　　者：米洋 刘凡 原小斌[1] 张彬[1] 王东文[1] 张旭辉[1] Mi Yang, Liu Fan, Yuan Xiaobin, Zhang Bin, Wang Dongwen, Zhang Xuhui(Department of Urology, the First Hospital of Shanxi Medical University Taiyuan 030001, China)

机构地区：[1]山西医科大学第一医院泌尿外科,太原030001

出　　处：《中国医师进修杂志》2018年第11期1007-1012,共6页Chinese Journal of Postgraduates of Medicine

基　　金：山西医科大学第一医院中青年学术技术带头人培育项目（YD1624）

摘　　要：目的从围手术期患者全身应激及机体免疫功能变化角度评估软性输尿管镜同期治疗双侧上尿路结石的可行性及安全性。方法选取2015年12月至2017年12月行软性输尿管镜碎石术（FURL）患者60例，依据治疗方法将患者分为FURL同期治疗双侧上尿路结石组（A组，29例）和FURL治疗单侧上尿路结石组（B组，31例）。记录两组患者围手术期情况。分别于术前1 d及术后1、3、5 d抽取外周静脉血检测血清肾上腺素（E）、去甲肾上腺素（NE）、皮质醇及外周血T淋巴细胞亚群。结果两组住院时间、并发症发生率和结石清除率等比较差异无统计学意义（P〉0.05），A组手术时间明显长于B组[（108.3 ± 11.5）min比（86.9 ± 13.3）min]，差异有统计学意义（P〈0.05）。两组围手术期血清E、NE、皮质醇及外周血CD3＋、CD4＋、CD8＋、CD4＋/CD8＋比较差异无统计学意义（P〉0.05）。两组仅术后1 d血清E、NE、皮质醇明显高于术前，差异有统计学意义（P〈0.05）；术后3 d与术前比较差异无统计学意义（P〉0.05）。两组术后1和3 d外周血CD3＋、CD4＋和CD4＋/CD8＋明显低于术前，CD8＋明显高于术前，差异有统计学意义（P〈0.05）；两组术后3 d外周血CD3＋、CD4＋和CD4＋/CD8＋明显高于术后1 d，CD8＋明显低于术后1 d，差异有统计学意义（P〈0.05）；两组术后5 d外周血CD3＋、CD4＋、CD8＋和CD4＋/CD8＋与术前比较差异无统计学意义（P〉0.05）。结论软性输尿管镜同期治疗双侧上尿路结石是可行、安全、有效的，并不增加患者围手术期全身应激反应及免疫抑制风险。ObjectiveTo evaluate the feasibility and safety of simultaneous flexible ureteroscopic in the treatment of bilateral upper urinary tract stones from systemic stress response and immune function changes. MethodsSixty bilateral upper urinary tract stones patients who had underwent flexible ureteroscopic lithotripsy （FURL） from December 2015 to December 2017 were selected. The patients were divided into simultaneous FURL treated bilateral upper urinary tract stones （group A, 29 cases） and FURL treated unilateral upper urinary tract stones （group B, 31 cases） according to the treatment method. The perioperative period indexes were recorded. The serum epinephrine （E）, norepinephrine （NE）, cortisol and peripheral blood T lymphocyte subsets 1 d before operation and 1, 3, 5 d after operation were detected. ResultsThere were no statistical differences in length of stay in hospital, incidence of postoperative complications and stone clearance rate between 2 group （P〉0.05）. The operating time in group A was significantly longer than that in group B： （108.3 ± 11.5） min vs.（86.9 ± 13.3） min, and there was statistical difference （P〈0.05）. There was no statistical differences in serum E, NE, cortisol and peripheral blood CD3＋, CD4＋, CD8＋, CD4＋/CD8＋ during perioperative period between 2 groups （P〉0.05）. The E, NE and cortisol levels only 1 d after operation in 2 groups were significantly higher than those before operation, and there were statistical differences （P〈0.05）; there were no statistical difference between 3 d after operation and before operation （P〉0.05）. Compared with those before operation, the peripheral blood CD3＋, CD4＋ and CD4＋/CD8＋ levels 1 and 3 d after operation in 2 groups were significantly lower, the CD8＋ was significantly higher, and there were statistical differences （P〈0.05）; compared with those 1 d after operation, the peripheral blood CD3＋, CD4＋ and CD4＋/CD8＋ levels 3 d after operation in 2 groups were signif

关 键 词：尿路结石 输尿管镜 T淋巴细胞亚群 全身应激反应 

分 类 号：R699[医药卫生—泌尿科学]