mPNL、SPCNL及FURL三种不同方式治疗肾结石患者的效果及对免疫功能与应激反应的影响  

Effect of three different ways of mPNL,SPCNL and FURL in the treatment of renal calculi and their effects on immune function and stress response

作　　者：潘文博[1] 吴天俊 魏波[1] 龙海[1] PAN Wen-bo;WU Tian-jun;WEI Bo(Department of Urology,the Second People's Hospital of Qinzhou,Qinzhou Guangxi 535000,China)

机构地区：[1]钦州市第二人民医院泌尿外科,广西钦州535000

出　　处：《临床和实验医学杂志》2022年第16期1725-1729,共5页Journal of Clinical and Experimental Medicine

基　　金：钦州市科学研究与技术开发计划项目(编号:20202735);广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z20191091)。

摘　　要：目的 探讨微通道经皮肾镜碎石术(mPNL)、标准通路经皮肾镜取石术(SPCNL)及输尿管软镜碎石术(FURL)三种不同方式治疗肾结石患者的效果及对免疫功能与应激反应的影响。方法 回顾性选择2020年2月至2021年6月在钦州市第二人民医院治疗的肾结石患者60例,根据手术方式不同将患者分为3组,每组20例。A组行SPCNL,B组行m PNL,C组行FURL。观察3组患者的术中、术后指标、肾功能指标、炎症因子[前列腺素E2(PGE2)、P物质、一氧化氮、过氧化脂]、氧化应激因子[血管紧张素I(Ang I)、血管紧张素Ⅱ(AngⅡ)、去甲肾上腺素(NE)]水平。结果C组患者的手术时间、卧床时间、住院时间、术中出血量显著优于A、B组,差异均有统计学意义(P<0.05);3组患者的一期结石清除率、最终结石清除率比较,差异均无统计学意义(P>0.05)。3组患者术后3 d的尿素氮、血肌酐、胱抑素C水平均明显高于术前,且C组患者的尿素氮、血肌酐、胱抑素C水平均明显低于A、B组;术后3 d,3组患者的CD4+、CD4^(+)/CD8^(+)均较术前明显降低,CD8^(+)较术前有提高,且C组CD4^(+)、CD4^(+)/CD8^(+)指标水平高于A组、B组,C组CD8^(+)指标水平低于A组、B组,差异均有统计学意义(P<0.05)。术后3 d,3组患者的PGE2、P物质、一氧化氮、过氧化脂水平均较术前明显升高,C组低于A组、B组,差异均有统计学意义(P<0.05)。术后3 d,3组患者的AngⅠ、AngⅡ、NE水平均较术前明显升高,但C组患者的AngⅠ、AngⅡ、NE水平均明显低于A、B组,差异均有统计学意义(P<0.05)。C组患者发热、出血、集合系统穿孔发生率稍低于A组和B组,但差异均有统计学意义(P> 0. 05)。结论 相比m PNL、SPCNL,FURL治疗肾结石的效果较好,手术时间较短,恢复较快,并且引起机体的炎症反应、氧化应激反应较轻,对免疫抑制的影响较小,值得在临床上广泛使用。Objective To investigate the effects of three different methods of microchannel percutaneous nephrolithotomy(mPNL),standard channel percutaneous nephrolithotomy(SPCNL)and flexible ureteroscopic lithotripsy(FURL)in the treatment of renal calculi and their effects on immune function and stress response.Methods A totao of 60 patients with renal calculi who were treated in Qinzhou Second People's Hospital from February 2020 to June 2021 were retrospectively selected.According to the operation methods,the patients were divided into 3 groups,each group 20 cases.Group A received SPCNL,group B received mPNL,and group C received FURL.The levels of intraoperative and postoperative indexes,kidney function indicators,inflammatory factors[prostaglandin E2(PGE2),substance P,nitric oxide,lipid peroxide]and oxidative stress factors were observed.Results The operation time,bed time,hospitalization time and intraoperative bleeding volume of group C were significantly better than those of group A and B,the differences were statistically significant(P<0.05);there were no statistically significant differences in the primary stone clearance rate and final stone clearance rate among the three groups(P>0.05).The levels of blood urea nitrogen,serum creatinine,and cystatin C in the three groups were significantly higher than those before operation 3 days after operation,the levels of blood urea nitrogen,serum creatinine,and cystatin C in group C were significantly higher than those in group A and B,the differences were statistically significant(P<0.05).Three days after operation,CD4^(+)and CD4^(+)/CD8^(+)in the three groups were significantly lower than those before operation,and CD8^(+)was higher than that before operation,the levels of CD4^(+)and CD4^(+)/CD8^(+)in group C were higher than those in group A and group B,and the levels of CD8^(+)in group C were lower than those in group A and group B,the differences were statistically significant(P<0.05).Three days after operation,the levels of PGE2,substance P,nitric oxide and lipid peroxi

关 键 词：肾结石 微通道经皮肾镜碎石术 标准通路经皮肾镜取石术 输尿管软镜碎石术 临床疗效 免疫功能 应激反应 

分 类 号：R699.2[医药卫生—泌尿科学]