输尿管支架引流术在老年上尿路结石伴尿源性脓毒血症的治疗效果及对血清ESM-1和PGE2水平的影响  

Therapeutic effects of ureteral stent drainage in elderly patients with upper urinary tract calculi complicated with urogenic sepsis and its effect on serum ESM-1 and PGE2 levels

作　　者：张卫东 宋志强 张佳伟 马哲 王文佳 李世海 吴建臣 ZHANG Wei-dong;SONG Zhi-qiang;ZHANG Jia-wei(Department of Urology,the First Affiliated Hospital of Tsinghua University,Beijing 100016,China.)

机构地区：[1]清华大学第一附属医院泌尿外科,北京100016

出　　处：《临床和实验医学杂志》2022年第12期1304-1307,共4页Journal of Clinical and Experimental Medicine

基　　金：北京首都特色临床研究项目(编号:Z161100000516167)。

摘　　要：目的探讨与分析输尿管支架引流术在老年上尿路结石伴尿源性脓毒血症的治疗效果及对血清内皮细胞特异性分子-1(ESM-1)和前列腺素-2(PGE2)水平的影响。方法前瞻性选择2018年3月1日至2022年3月10日在清华大学第一附属医院急诊收治的上尿路结石伴尿源性脓毒血症老年患者106例作为研究对象,根据1∶1随机信封抽签原则把患者分为研究组与对照组各53例。对照组给予经皮肾镜造瘘手术治疗,研究组给予输尿管支架引流术治疗,检测血清ESM-1和PGE2水平变化情况。结果研究组与对照组的一次性结石清除成功率分别为94.34%和98.11%,组间比较差异无统计学意义(P>0.05)。两组术后引流管拔除时间、术中出血量对比差异无统计学意义(P>0.05);研究组的手术时间、术后住院时间、术后胃肠道功能恢复时间为(74.29±11.47)min、(8.27±0.22)d、(2.11±0.32)d,明显少于对照组[(104.38±12.40)min、(11.37±1.14)d、(3.10±0.27)d],差异均有统计学意义(P<0.05)。两组术后14 d的血清ESM-1和PGE2含量明显低于术前,研究组血清ESM-1和PGE2含量为(0.76±0.09)ng/mL、(211.20±15.07)ng/L,明显低于对照组[(1.21±0.17)ng/mL、(298.38±19.38)ng/L],差异均有统计学意义(P<0.05)。研究组术后14 d的输尿管狭窄、出血、腹腔感染、肠梗阻等并发症发生率为3.78%,明显低于对照组的24.53%,差异有统计学意义(P<0.05)。结论输尿管支架引流术在老年上尿路结石伴尿源性脓毒血症的应用可缩短手术时间、术后住院时间、术后胃肠道功能恢复时间,并不会明显降低一次性结石清除成功率,可降低并发症的发生率,能抑制血清ESM-1和PGE2的释放。Objective To investigate and analysis the therapeutic effects of ureteral stent drainage in elderly patients with upper urinary tract calculi complicated with urogenic sepsis and its effect on serum endothelial cell specific molecule-1(ESM-1)and prostaglandin-2(PGE2)levels.Methods From March 1,2018 to March 10,2022,106 cases of elderly patients with upper urinary tract calculi and urosepticemia in the Department of Emergency,the First Affiliated Hospital of Tsinghua University were prospectively selected as the research subjects.The patients were divided into the study group and the control group with 53 cases in each groups.The control group were treated with percutaneous nephrostomy,and the study group were treated with ureteral stent drainage,and the changes of serum ESM-1 and PGE2 levels were detected.Results The success rates of one-time stone removal in the study group and the control group were 94.34%and 98.11%,respectively,and there were no significant difference compared between the groups(P>0.05).There were no significant difference in the postoperative drainage tube removal time and intraoperative blood loss compared between the two groups(P>0.05).The operation time,postoperative hospital stay,and postoperative gastrointestinal function recovery time of the study group were(74.29±11.47)min,(8.27±0.22)d,and(2.11±0.32)d,which were significantly shorter than those of the control group[(104.38±12.40)min,(11.37±1.14)d,(3.10±0.27)d],the differences were statistically significant(P<0.05).The levels of serum ESM-1 and PGE2 in the two groups at 14 days after operation were significantly lower than those before operation(P<0.05),and the levels of serum ESM-1 and PGE2 in the study group were(0.76±0.09)ng/mL,(211.20±15.07)ng/L,which were significantly lower than those in the control group[(1.21±0.17)ng/mL,(298.38±19.38)ng/L],the differences were statistically significant(P<0.05).The incidence rate of complications such as ureteral stricture,hemorrhage,intra-abdominal infection and intestinal obstruction

关 键 词：输尿管支架引流术 老年人 上尿路结石 尿源性脓毒血症 前列腺素-2 内皮细胞特异性分子-1 

分 类 号：R699[医药卫生—泌尿科学]