输尿管软镜及微造瘘经皮肾镜碎石治疗肾下盏结石的临床疗效及对血清降钙素原、C反应蛋白、白细胞介素-6水平的影响

doi:10.3969/j.issn.1005-6483.2021.11.021

摘要/Abstract

摘要： 目的比较输尿管软镜碎石术(FURSL)及微造瘘经皮肾镜碎石(MPCNL)处理肾下盏结石的疗效及对血清降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素(IL)-6水平的的影响。
方法我院2018年1月～2020年12月收治的肾下盏结石病人102例。根据治疗方法不同分为两组，FURSL组50例，行FURSL治疗，MPCNL组52例，行MPCNL治疗。比较两组碎石成功率、并发症，分别于术前及术后24小时、72小时检测两组病人血清PCT、CRP、IL-6水平。
结果 FURSL组病人一次性结石取净率、手术时间分别为70.00%、(46.83±4.09)分钟，MPCNL组分别为88.46%和(35.47±6.33)分钟，两组比较差异有统计学意义(P＜0.05)；FURSL组术后迟发性出血发生率、血红蛋白下降值分别为0和(2.72±0.65)g/L，MPCNL组分别为13.46%和(3.18±0.74)g/L，两组比较差异有统计学意义(P＜0.05)。MPCNL组病人术后第24小时、72小时的血清PCT、CRP、IL-6水平分别为(0.11±0.04)ng/ml、(10.50±2.64)mg/L、(12.12±3.23)pg/ml，(0.07±0.02)ng/ml、(12.38±1.91)mg/L、(11.32±3.23)pg/ml，FURSL组分别为(0.09±0.03)ng/ml、(9.46±2.53)mg/L、(10.01±2.74)pg/ml，(0.06±0.01)ng/ml、(11.22±1.74)mg/L、(9.28±2.53)pg/ml，MPCNL组均高于FURSL组，差异有统计学意义(P＜0.05)。
结论 FURSL与MPCNL均可以用于治疗直径2～3cm肾下盏结石，MPCNL的取石效率高，FURSL的创伤小、出血少、术后炎症反应轻。

关键词: 输尿管软镜, 肾下盏结石, 微造瘘经皮肾镜

Abstract: Objective To study the effect of flexible ureteroscopic lithotripsy(FURSL)and miniaturized percutaneous nephrolithotomy(MPCNL)on lower-calyx calculi in elderly patients and their effects on PCT,CRP and IL-6 levels in patients with lower-calyx calculi.
Methods A total of 102 patients who underwent FURSL(n=50) or MPCNL(n=52) for subrenal calyx calculus stones from January 2018 to December 2020 were retrospectively analyzed.the Intraoperative and postoperative data including stone-free rate and complications were compared,the levels of serum PCT,CRP and IL-6 were detected before and 24 h after operation.
Results The one-time stone removal rate and operation time of FURSL group[70.00%,(46.83±4.09)min] were lower than those of MPCNL group[88.46%,(35.47±6.33)min](P<0.05).Compared with MPCNL group,the incidence of delayed bleeding and the decrease of hemoglobin in FURSL group[0,(2.72±0.65)g/L] were better than MPCNL Group[13.46%,(3.18±0.74)g/L] with significant difference(P<0.05).The serum levels of PCT,CRP and IL-6 were (0.11±0.04)ng/ ml,(10.50±2.64)mg/L,(12.12±3.23)pg/ml and (0.07±0.02)ng/ml,(12.38±1.91)mg/L,(11.32±3.23)pg/ml at 24h and 72h after MPCNL,respectively,and those in FURSL group were (0.09±0.03)ng/ml,(9.46±2.53)mg/L,(10.01±2.74)pg/ml and (0.06±0.01)ng/ml,(11.22 ±1.74)mg/L,(9.28±2.53)pg/ml,respectively.MPCNL group was higher than FURSL group(all P<0.05).
Conclusion FURSL and MPCNL are both effective and safe for treating subrenal calyx caculus with a diameter of 2～3cm.MPCNL shows more higher stone free rate.However,FURSL is associated with less reauma,less bleeding and mild inflammatory reaction.

Key words: flexible ureteroscopic lithotripsy, subrennal calyx caculus, miniaturized percutaneous nephrolithotomy

黄志强李虎马楠孔德志. 输尿管软镜及微造瘘经皮肾镜碎石治疗肾下盏结石的临床疗效及对血清降钙素原、C反应蛋白、白细胞介素-6水平的影响[J]. 临床外科杂志, 2021, 29(11): 1068-1070.

HUANG Zhiqiang, LI Hu, MA Nan, et al.. Effect of flexible ureteroscopic lithotripsy and miniaturized percutaneous nephrolithotomy on lower-calyx calculi and the level of procalcitonin,C reactive protein and IL-6 levels in patients with lower-calyx calculi of elderly patients[J]. JOURNAL OF CLINICAL SURGERY, 2021, 29(11): 1068-1070.

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