硕通镜与输尿管软镜治疗上尿路结石合并脓肾对清石率、尿脓毒血症、T淋巴细胞亚群的影响

目的 探讨硕通镜与输尿管软镜治疗上尿路结石合并脓肾对清石率、尿脓毒血症、T淋巴细胞亚群的影响。 方法 前瞻性选取2018年1月~2019年12月我院收治的102例上尿路结石合并脓肾患者，随机数字表法分为2组，每组51例。两组术前均行B超引导下肾穿刺引流脓液与抗菌治疗，炎症控制后，硕通镜组给予硕通镜钬激光碎石术，输尿管软镜组给予输尿管软镜钬激光碎石术。比较两组手术时间、术后住院时间、置鞘成功率、术后第1 d和术后1个月清石率、炎性因子C反应蛋白（CRP）、白介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）水平、T淋巴细胞亚群（CD3+、CD4+、CD4+/CD8+）、肾功能指标尿中α1微球蛋白（α1-MG）、血尿素氮（BUN）、血肌酐（SCr）、血清胱抑素C（Cys-C）、肾小球滤过率（GFR）、并发症发生情况。 结果 硕通镜组手术时间长于输尿管软镜组（P<0.05）；硕通镜组术后第1 d清石率（84.31%）高于输尿管软镜组（66.67%）（P<0.05）；两组术后1个月清石率（96.08%、92.16%）比较，差异无统计学意义（P>0.05）；硕通镜组术后6 h、术后24 h CRP、IL-6、TNF-α低于输尿管软镜组（P<0.05）；硕通镜组术后6 h、术后24 h CD3+、CD4+、CD4+／CD8+水平高于输尿管软镜组（P<0.05）；两组术前、术后2周α1-MG、BUN、SCr、Cys-C、GFR比较，差异无统计学意义（P>0.05）；组间并发症总发生率（1.96%、5.88%）比较，差异无统计学意义（P>0.05）。 结论 硕通镜与输尿管软镜治疗上尿路结石合并脓肾均安全有效，但硕通镜术后早期清石率较高，并能改善围手术期炎症反应与机体细胞免疫。

Effects of Shuotongscope and ureteroscopy on the treatment of upper urinary tract stones combined with pyogenic kidney on clearing rate,urosepsis and T lymphocyte subsets

Objective To explore the effect of Shuotongscope and ureteroscopy on the treatment of upper urinary tract stones combined with pyogenic kidney on clearing rate, urosepsis and T lymphocyte subsets. Methods From January 2018 to December 2019, 102 patients with upper urinary tract stones combined with pyogenic kidneys were selected and divided into 2 groups according to random number table method, 51 cases in each group. Both groups underwent renal puncture and drainage of pus and antibacterial treatment under the guidance of B ultrasound before operation. After controlling the inflammation, the Shuotongscope group was given the Shuotongscope holmium laser lithotripsy, and the ureter soft mirror group was given the ureter soft mirror holmium laser lithotripsy. The operation time, postoperative hospital stay, success rate of sheath insertion, stone removal rate at 1 d and 1 month after operation, inflammatory factors C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)] levels, T-lymphocyte subsets (CD3+, CD4+, CD4+/CD8+), renal function indexes urinary α1 microglobulin (α1-MG), blood urea nitrogen (BUN), blood creatinine (SCr), serum cystatin C (Cys-C), glomerular filtration rate (GFR)], complications of the two groups were compared. Results The operation time of the Shuotongscope group was longer than that of the flexible ureteroscope group (P<0.05). The stone clearing rate (84.31%) on the 1st postoperative day of the Shuotongscope group was higher than that of the flexible ureteroscope group (66.67%) (P<0.05). The stone removal rate (96.08%, 92.16%) of the two groups after 1 month of operation was not statistically significant. CRP, IL-6 and TNF-α in the Shuotongscope group were lower than those in the flexible ureteroscope group at 6 h and 24 h after operation (P<0.05). The number of CD3+, CD4+, CD4+/CD8+ in the Shuotongscope group was higher than that in the flexible ureteroscope group at 6 h and 24 h after operation (P<0.05). There was no significant difference in α1-MG, BUN, SCr, Cys-C, and GFR between the two groups before operation and 2 weeks after operation. There was no statistically significant difference in the total incidence of complications (1.96%, 5.88%) between groups. Conclusions Shuotongscope and flexible ureteroscope are safe and effective in treating upper urinary tract stones with pyogenic kidney, but the early stone clearing rate after Shuotongscope is higher, and it can improve the perioperative inflammatory reaction and body cellular immunity.