F-RURS治疗复杂性输尿管上段结石对结石清除情况及应激激素、免疫功能的影响分析  

Influence Analysis of F-RURS on Stone Clearance,Stress Hormones and Immune Function in the Treatment of Complex Upper Ureteral Calculi

作　　者：吴清华 刘敦龙 WU Qinghua;LIU Dunlong(Jianli Traditional Chinese Medicine Hospital,Jianli 433300,China;不详)

机构地区：[1]监利市中医医院,湖北监利433300 [2]监利市第四人民医院

出　　处：《中外医学研究》2023年第12期27-31,共5页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:探讨经尿道输尿管软镜联合硬镜下钬激光碎石术(F-RURS)治疗复杂性输尿管上段结石(CUUC)对结石清除情况及应激激素、免疫功能的影响。方法:选取2020年1月—2021年10月监利市中医医院收治的92例CUUC患者,并根据随机数表法将其分为F-RURS组(F-RURS治疗)46例与对照组(经皮肾镜取石术治疗)46例。记录两组围手术期相关指标、手术前后应激激素水平与免疫功能指标、结石清除情况、术后3个月内并发症及术后1年复发率并进行统计学分析。结果:F-RURS组手术时间明显长于对照组,术中出血量明显少于对照组,术后拔导尿管时间早于对照组,住院时间短于对照组,差异有统计学意义(P<0.05)。两组术后24 h血清促肾上腺皮质激素(ACTH)、肾上腺素(E)、去甲肾上腺素(NE)及皮质醇(Cor)水平均明显高于术前,F-RURS组血清ACTH、E、NE及Cor水平均明显低于对照组,差异有统计学意义(P<0.05)。两组术后24 h CD3^(+)、CD4^(+)T淋巴细胞水平及CD4^(+)/CD8^(+)均明显低于术前,CD8^(+)T淋巴细胞水平均明显高于术前,差异有统计学意义(P<0.05);F-RURS组术后24 h CD3^(+)、CD4^(+)T淋巴细胞水平及CD4^(+)/CD8^(+)均明显高于对照组,而CD8^(+)T淋巴细胞水平明显低于对照组,差异有统计学意义(P<0.05)。F-RURS组结石清除率明显高于对照组,而术后3个月内并发症发生率及术后1年复发率均明显低于对照组,差异有统计学意义(P<0.05)。结论:CUUC患者给予F-RURS治疗,术中出血少、结石清除率高,术后恢复快,能有效缓解术后应激反应及改善免疫功能,并发症少且复发率低,优势明显。Objective:To explore the influence of flexible ureteroscope combined with rigid ureteroscope holmium laser lithotripsy(F-RURS)on stone clearance,stress hormones and immune function in the treatment of complex upper ureteral calculi(CUUC).Method:A total of 92 cases of CUUC patients admitted to Jianli Traditional Chinese Medicine Hospital from January 2020 to October 2021 were selected and divided into F-RURS group(F-RURS)46 cases and control group(percutaneous nephrolithotomy)46 cases according to random number table method.The perioperative related indicators,stress hormone levels and immune function indicators before and after surgery,stone clearance,complications within 3 months after surgery and 1 year recurrence rate of the two groups were recorded and statistically analyzed.Result:The operation time of F-RURS group was significantly longer than that of control group,the amount of intraoperative blood loss was significantly less than that of control group,the time of postoperative catheter extraction was earlier than that of control group,and the length of hospital stay was shorter than that of control group,the differences were statistically significant(P<0.05).The levels of serum adrenocorticotropic hormone(ACTH),epinephrine(E),norepinephrine(NE)and cortisol(Cor)in two groups at 24 h after operation were significantly higher than those before operation,and the levels of serum ACTH,E,NE and Cor in F-RURS group were significantly lower than those in control group,the differences were statistically significant(P<0.05).At 24 h after operation,the levels of CD3+,CD4+T lymphocytes and CD4+/CD8+in two groups were significantly lower than those before operation,and the levels of CD8+T lymphocytes in two groups were significantly higher than those before operation,the differences were statistically significant(P<0.05),the levels of CD3+,CD4+T lymphocytes and CD4+/CD8+lymphocytes in F-RURS group at 24 h after operation were significantly higher than those in control group,while the level of CD8+T lymphocytes was sign

关 键 词：复杂性输尿管上段结石 尿道输尿管软镜联合硬镜下钬激光碎石术 结石清除率 应激激素 免疫功能 

分 类 号：R699.4[医药卫生—泌尿科学]