完全无管化经皮肾镜取石术治疗直径1cm及以下肾结石  

Efficacy of totally tubeless percutaneous nephrolithotomy in the treatment of renal calculi with diameter≤1cm

作　　者：黄静[1] 程树林[1] 程艳 唐铁龙[1] 祝晓娟 周斌[2] HUANG Jing;CHENG Shulin;CHENG Yan;TANG Tielong;ZHU Xiaojuan;ZHOU Bin(Department of Urology,The Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,Sichuan,China;Translational Medicine Center,West China Second Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]川北医学院附属医院泌尿外科,四川南充637000 [2]四川大学华西第二医院转化医学中心,四川成都610041

出　　处：《西部医学》2020年第4期527-531,共5页Medical Journal of West China

基　　金：四川省卫生和计划生育委员会科研课题重点研究项目(18PJ456)。

摘　　要：目的探讨完全无管化经皮肾镜取石术(PCNL)与传统PCNL对结石直径≤1 cm肾结石患者清石效果、炎症因子水平、免疫功能指标及生活质量的影响。方法选取2017年1月~2018年10月于四川大学华西第二医院择期行PCNL治疗的100例肾结石患者为研究对象,根据手术方式不同分为观察组(完全无管化PCNL,n=54)与对照组(传统PCNL,n=46)。比较两组手术时间、术中出血量、住院时间、术后血红蛋白(Hb)下降量、结石清除率、术后止痛药用量、术后并发症发生率及手术前后炎症因子水平[前列腺素E2(PGE2)、P物质(SP)、一氧化氮(NO)、过氧化脂(LPO)]、免疫功能指标、SF-36生活质量量表评分变化。结果两组手术时间、术中出血量及术后Hb下降量比较,差异无统计学意义(P>0.05);观察组住院时间显著短于对照组,结石清除率显著高于对照组,术后止痛药用量显著少于对照组,差异有统计学意义(均P<0.05);两组术后并发症发生率比较,差异无统计学意义(P>0.05);术后两组PGE2、SP、NO、LPO炎症因子水平均有显著升高,但观察组显著低于对照组(P<0.05);术后两组CD+4、CD+4/CD+8水平均有显著降低,CD+8水平显著提高,且观察组变化更小(P<0.05)。术后观察组SF-36生活质量评分显著高于对照组(P<0.05)。结论完全无管化PCNL治疗结石直径≤1 cm肾结石的清石效果较好,可明显减轻患者术后不适和疼痛,减少止痛药用量,且不增加术后并发症风险,在一定程度上减轻机体炎症应激反应及免疫抑制现象,提高患者术后生活质量。Objective To explore the effects of totally tubeless percutaneous nephrolithotomy(PCNL) and conventional PCNL on stone clearance effects, levels of inflammatory factors, immune function indexes and quality of life of patients with renal calculi of diameter ≤1 cm. Methods 100 patients with renal calculi who underwent selective PCNL treatment in department of urinary surgery in our hospital from January 2017 to October 2018 were selected for the study group and were divided into observation group(totally tubeless PCNL, n=54) and control group(conventional PCNL, n=46) according to different surgical methods. The operative time, intraoperative blood loss, hospital stay, decrease of postoperative hemoglobin(Hb), stone clearance rate, postoperative analgesic dose, incidence rate of postoperative complications, changes in levels of inflammatory factors [prostaglandin E2(PGE2), substance P(SP), nitric oxide(NO), lipid peroxide(LPO)], immune function indexes and SF-36 quality of life scores before and after surgery were compared between the two groups. Results There were no significant differences in the operative time, intraoperative blood loss and postoperative Hb decrease between the two groups(P>0.05). The hospital stay in observation group was significantly shorter than that in control group, and the stone clearance rate was significantly higher than that in control group, and the postoperative analgesic dose was significantly lower than that in control group(P<0.05). There was no significant difference in the incidence rate of postoperative complications between the two groups(P>0.05). Levels of PGE2, SP, NO and LPO in both groups were significantly increased after operation, but the levels in observation group were significantly lower than those in the control group(P<0.05). Levels of CD■and CD+4/CD+8 in both groups decreased significantly after operation while the level of CD+8 increased significantly. Changes in the observation group were smaller(P<0.05). The postoperative SF-36 quality of life score in obser

关 键 词：完全无管化经皮肾镜取石术 肾结石 清石效果 炎症因子 免疫功能 生活质量 

分 类 号：R692.4[医药卫生—泌尿科学]