输尿管钬激光碎石术治疗输尿管上段结石的临床效果及对炎性反应指标的影响

摘要

目的 探讨输尿管钬激光碎石术对输尿管上段结石的临床治疗效果及对炎性、应激反应指标的影响.方法 选取我院治疗的146例输尿管上段结石患者,收治时间2015年1月至2017年1月,根据手术方式分为A组69例(输尿管钬激光碎石术)、B组77例(体外冲击波碎石术),对比两组的手术效果、安全性指标.结果 A组患者的手术时间显著低于B组(P＜0.05),A组患者的碎石成功率、术后3个月结石排净率及住院时间均显著高于B组(P＜0.05);A组患者的并发症率(5.80％)与B组(7.79％)比较,差异无统计学意义(P＞0.05);术前和术后第3天,A组和B组患者的血清IL-2、IL-6、TNF-a、ET-1、PGE2组间比较,差异均无统计学意义(P＞0.05);术后第3天,各组患者的血清IL-6、TNF-a、ET-1、PGE2水平较术前显著升高(P＜0.05),IL-2水平较术前显著降低(P＜0.05).结论 输尿管钬激光碎石术治疗输尿管上段结石效果较好,与体外冲击波碎石术比较并不会增加患者的炎症及应激反应程度.%Objective To investigate the clinical efficacy and safety of holmium laser lithotripsy in the treatment of upper ureteral calculi and its effects on inflammatory reactions.Methods A total of 146 cases of ureteral calculi treated in our hospital during Jan.2015 and Jan.2017 were divided into two groups,group A (n =69,received ureteral holmium laser lithotripsy)and group B (n =77,received extracorporeal shock wave lithotripsy,ESWL).The clinical indexes and inflammatory reactions of the two groups were compared.Results Group A needed significantly shorter operation time than group B,but it had higher success rate,postoperative 3-month stone free rate,and longer hospital stay than group B (all P＜0.05).There were no significant differences in the IL-2,IL-6,TNF-a,ET-1 and PGE2 between the two groups before operation and 3 days after operation (all P＞0.05),but IL-6,TNF-α,ET-1,PGE2 were significantly higher after operation (all P＜0.05) while IL-2 was significantly lower (P＜0.05).Conclusion Holmium laser lithotripsy is safe and effective in the treatment of upper ureteral calculi.Compared with extracorporeal shock wave lithotripsy,it does not increase inflammatory and stress reactions.