输尿管软镜激光碎石与体外冲击波碎石在肾下盏结石患者中的疗效及对不良应激的控制

目的 观察并比较输尿管软镜激光碎石(URL)与体外冲击波碎石(ESWL)在肾下盏结石患者中的疗效及对不良应激的控制效果.方法 选取2015年10月至2016年9月期间绵阳市第三人民医院收治的98例肾下盏结石患者为研究对象,将其根据随机数字表法分为A组(体外冲击波碎石组)49例和B组(输尿管软镜激光碎石组)49例,将两组中不同结石直径及结石情况患者的结石清除率、重复治疗率、手术时间、感染率、治疗费用、手术前后的应激激素及炎性应激指标进行检测与比较.结果 B组中不同结石直径(<10 mm及≥10 mm)及结石情况(复杂结石及非复杂结石)患者的结石清除率分别为100.00%、96.43%、94.74%及100.00%,均高于A组的75.00%、86.21%、73.68%及86.67%,重复治疗率及感染率分别为0、3.57%、5.26%、0及4.76%、3.57%、10.53%、0,均低于A组的15.00%、20.69%、26.32%、13.33%及25.00%、20.69%、31.58%、16.67%,差异均有统计学意义(P<0.05),而两组手术时间分别为(60.12±5.72)min、(70.03±6.23)min、(69.79±6.12)min、(59.32±5.45)min及(58.23±5.45)min、(67.87±5.99)min、(68.78±6.02)min、(57.67±5.66)min,差异无统计学意义(P>0.05),B组的治疗费用分别为(17052.25±356.78)元、(17899.95±370.84)元、(18026.35±381.61)元及(17045.42±340.12)元,高于A组的(1872.52±145.66)元、(1998.84±201.53)元、(2104.52±220.23)元及(1763.64±139.82)元,差异有统计学意义(P<0.05);术后12 h、24 h及48 h B组的应激激素(Cor、NE及ALD)及炎性应激指标(TNF-α、IL-6及IL-18)分别低于A组(P<0.05).结论 输尿管软镜激光碎石在肾下盏结石患者中的疗效明显优于体外冲击波碎石治疗,其对不良应激的控制效果相对更好,临床应用价值相对更高.

Effect of flexible ureteroscopy combined with holmium laser lithotripsy and extracorporeal shock wave lithotripsy in the patients with lower calyx calculi and their control effect for the adverse stress

Objective To observe and compare the effect of flexible ureteroscopy combined with holmium la-ser lithotripsy and extracorporeal shock wave lithotripsy in the patients with lower calyx calculi and their control effect for the adverse stress. Methods A total of 98 patients with lower calyx calculi, who admitted to our hospital from Octo-ber 2015 to September 2016, were selected divided into the group A (extracorporeal shock wave lithotripsy group) and group B (flexible ureteroscopy combined with holmium laser lithotripsy) according to the random number table, with 49 cases in each group. The stone clearance rates, repeated treatment rates, operative time, infection rate, treatment cost, stress hormone and inflammatory stress before and after surgery of two groups with different stone diameters and stone types were detected and compared. Results The stone clearance rates of the group B with different stone diameter (<10 mm and≥10 mm) and stone types (complex calculi and non-complex calculi) were respectively 100.00%, 96.43%, 94.74%and 100.00%, which were all significantly higher than 75.00%, 86.21%, 73.68%and 86.67%of the group A (P<0.05). The repeated treatment rates and infection rates were respectively 0, 3.57%, 5.26%, 0 and 4.76%, 3.57%, 10.53%, 0, which were all significantly lower than 15.00%, 20.69%, 26.32%, 13.33%and 25.00%, 20.69%, 31.58%, 16.67%of the group A (P<0.05). The operation time of two groups were respectively (60.12 ± 5.72) min, (70.03 ± 6.23) min, (69.79 ± 6.12) min, (59.32 ± 5.45) min and (58.23 ± 5.45) min, (67.87 ± 5.99) min, (68.78 ± 6.02) min, (57.67 ± 5.66) min, and the differences were not statistically significant (P>0.05). The costs of the group B were respectively (17052.25± 356.78) yuan, (17899.95 ± 370.84) yuan, (18026.35 ± 381.61) yuan and (17045.42 ± 340.12) yuan, which were signifi-cantly higher than (1872.52 ± 145.66) yuan, (1998.84 ± 201.53) yuan, (2104.52 ± 220.23) yuan and (1763.64 ± 139.82) yuan (P<0.05). The stress hormones indexes (Cor, NE and ALD) and inflammatory stress indexes (TNF-α, IL-6 and IL-18) at 12 h, 24 h and 48 h after the operation were significantly lower than the levels of the group A (P<0.05). Conclusion Flexible ureteroscopy combined with holmium laser lithotripsy has better clinical effect than extracorpore-al shock wave lithotripsy in the patients with lower calyx calculi, which also has better control effect for the adverse stress, so its clinical application value is higher.