RLU术和URL术对复杂性输尿管上段结石患者尿流动力学和炎症应激的影响  

Effects of Retroperitoneal Laparoscopic Ureterolithotomy and Ureteroscopic Lithotripsy on Urodynamics and Inflammatory Stress in Patients with Complicated Upper Ureteral Calculi

作　　者：张寒 魏仁波[1] 乔超 曹敏[1] 席翔[1] ZHANG Han;WEI Renbo;QIAO Chao;CAO Min;XI Xiang(Chengdu Third People’s Hospital,Chengdu 610031,China)

机构地区：[1]成都市第三人民医院,四川成都610031

出　　处：《北华大学学报（自然科学版）》2023年第4期495-499,共5页Journal of Beihua University（Natural Science）

基　　金：成都市科技发展计划项目(2019-YF05-00494-SN).

摘　　要：目的探讨后腹腔镜输尿管切开取石术(RLU)和输尿管镜碎石术(URL)在复杂性输尿管上段结石患者中的应用效果及对患者尿流动力学、炎症应激的影响.方法回顾性分析155例复杂性输尿管上段结石患者的临床资料,根据手术方式不同分为RLU组(84例)和URL组(71例),记录两组手术时间、术中出血量、术后下床活动时间、住院时间及住院费用,比较两组患者一次性结石清除率、术后并发症、手术前后尿流动力学(最大尿流速率(Qmax)、最大尿道压力(MUP))及炎症应激指标(C-反应蛋白(CRP)、白介素-6(IL-6)、前列腺素E_(2)(PGE_(2))).结果RLU组患者手术时间、术后下床活动时间、总住院时间均长于URL组(P<0.05),术中出血量、住院费用均多于URL组(P<0.05);RLU组一次性结石清除率为100%,高于URL组的85.92%(P<0.05);RLU组并发症总发生率为9.52%,与URL组(5.63%)比较差异无统计学意义(P>0.05);术后两组患者Qmax、MUP均高于术前(P<0.05),且RLU组与URL组比较差异无统计学意义(P>0.05);术后,两组患者血清CRP、IL-6、PGE_(2)水平均较术前升高(P<0.05),且RLU组高于URL组(P<0.05).结论RLU术与URL术均是复杂性输尿管上段结石的安全、有效术式,两种术式比较RLU术一次性结石清除率更高,但URL术手术创伤小,对患者炎症应激影响更小.Objective To compare the application effects of retroperitoneal laparoscopic ureterolithotomy(RLU)and ureteroscopic lithotripsy(URL)on patients with complicated upper ureteral calculi and their effects on urodynamics and inflammatory stress.Method The clinical data of 155 patients with complicated upper ureteral calculi were retrospectively analyzed.According to different surgical Method s,the patients were divided into RLU group(84 cases)and URL group(71 cases).Surgical time,intraoperative blood loss,postoperative ambulation time,hospital stay and hospitalization cost were recorded in the two groups.The one-time stone clearance rate,postoperative complications and urodynamics(maximum urine flow rate(Qmax),maximum urethral pressure(MUP))and inflammatory stress indicators(C-reactive protein(CRP),interleukin-6(IL-6),prostaglandin E_(2)(PGE_(2)))of the two groups were compared.Results The surgical time,postoperative ambulation time and total hospital stay in the RLU group were longer than those in the URL group(P<0.05),and the intraoperative blood loss and hospitalization cost were higher than those in the URL group(P<0.05).The one-time stone clearance rate of 100%in the RLU group was higher than 85.92%in the URL group(P<0.05).The total incidence rate of complications was 9.52%in the RLU group,which was not significantly different from 5.63%in the URL group(P>0.05).After surgery,the Qmax and MUP of the two groups were enhanced comparing with those before surgery(P<0.05),and there were no statistical differences between the RLU group and the URL group(P>0.05).After surgery,the levels of serum CRP,IL-6 and PGE_(2) in the two groups were higher than those before surgery(P<0.05),and the levels were higher in the RLU group than those in the URL group(P<0.05).Conclusion Both RLU and URL are safe and effective procedures for complicated upper ureteral calculi.In contrast,RLU has a higher one-time stone clearance rate,but URL has smaller surgical trauma and less impact on inflammatory stress of patients.

关 键 词：复杂性输尿管上段结石 后腹腔镜切开取石术 输尿管镜碎石术 尿流动力学 炎症应激 

分 类 号：R693.4[医药卫生—泌尿科学]