软、硬输尿管镜钬激光治疗输尿管上段结石对机体应激反应对比研究

摘要

目的 研究分析软、硬输尿管镜钬激光治疗输尿管上段结石对机体应激反应,通过对比得出科学结论.方法 选取2014年4~12月间40例在我院接受治疗的输尿管上段结石患者,采用随机数字表法分为实验组与对照组,实验组采用软式输尿管镜钬激光治疗,对照组采用硬式输尿管镜钬激光治疗.分别于手术当日晨、术后第 1、3、5天抽取静脉血测血C反应蛋白(CRP)、血清白细胞介素-6(IL-6)以及皮质醇(Cor)的水平.结果 实验组与对照组患者手术当日晨CRP、IL-6、Cor质量浓度分别为:(2?53 ± 1.12 )mg/L、(1.1 ± 0.42)ng/L、(203.15 ± 18.62)ng/mL和(2.41 ± 1.05)mg/L、(1.0 ± 0.4)ng/L、(203.13 ± 18.65)ng/mL,两组比较差异无统计学意义(P > 0.05 ).术后第1、3、5天,实验组 CRP分别为(218.64 ± 20.53 )、(231.57 ± 21.86 )、(223?57 ± 21.28)mg/L,IL-6分别为(18.65 ± 7.11)、(30.25 ± 14.32)、(19.26 ± 7.89)ng/mL,Cor分别为(22.64 ± 10.11)、(18?85 ± 8.32)、(12.26 ± 4.89)ng/mL ;对照组CRP分别为(245.87 ± 22.95)、(263.69 ± 25.10)、(251.36 ± 23.76)mg/L,IL-6分别为 (26.63 ± 1.62)、(46.23 ± 6.98)、(29.12 ± 2.82) ng/mL,Cor 分别为(31.23 ± 5.93)、(25.30 ± 4.98)、(18.12 ± 2.82) ng/mL,实验组水平明显低于对照组,差异有统计学意义(P<0.05).结论 软式输尿管镜钬激光治疗输尿管上段结石对机体免疫应激反应小于硬式输尿管镜钬激光碎石术,显著提高了患者的生活质量,更符合现代泌尿外科微创治疗理念.%Objective To compare the stress response caused by flexible and rigid ureteroscope combined with holmium la-ser for the treatment of upper ureteral stones.Methods A total of 40 cases of upper ureteral calculi treated in our hospital during Apr.and Dec.2014 were selected and randomly divided into flexible ureteroscope treatment group and rigid uretero-scope treatment group.Both groups received treatment of holmium laser.Peripheral blood samples were collected before sur-gery,1 day,3 and 5 days after surgery,to measure the C-reactive protein (CRP),serum interleukin-6 (IL-6) and cortisol (Cor) concentration in the serum.Data collected were analyzed with SPSS13.0 software.Results Baseline serum CRP,IL-6 and Cor levels of flexible ureteroscope treatment group and rigid ureteroscope treatment group were:(2.53 ± 1.12)vs.(2.41 ± 1.05) mg/L,(1.1 ± 0.42)vs.(1.0 ± 0.4) ng/L,(203.15 ± 18.62)vs.(203.13 ± 18.65) ng/mL,and the difference between the two groups was not statistically significant ( P>0?05).On day 1,3,and 5 after surgery,in the flexible ureteroscope treat-ment group,CRP was (218.64 ± 20.53),(231.57 ± 21.86) and (223.57 ± 21.28) mg/L ;IL-6 was (18.65 ± 7.11),(30.25 ± 14.32),(19.26 ± 7.89) ng/mL ;Cor was (22.64 ± 10.11),(18.85 ± 8.32),(12.26 ± 4.89) ng/mL ;in the rigid ureteroscope treatment group,CRP was (245.87 ± 22.95),(263.69 ± 25.10),(251.36 ± 23.76) mg/L ;IL-6 was (26.63 ± 1.62),(46.23 ± 6.98),(29.12 ± 2.82) ng/mL;Cor was (31.23 ± 5.93),(25.30 ± 4.98),(18.12 ± 2.82) ng/mL.The postoperative CRP,IL-6 and Cor concentrations of both groups were higher than baseline.These indexes of the flexible ureteroscope treatment group were lower,and difference between the two groups was statistically significant (P<0.05).Conclusions The stress response of patients treated with flexible ureteroscope is less than those treated with rigid ureteroscope,indicating that flexible uretero-scope treatment can significantly help to ensure patients' quality of life.Flexible ureteroscope is more minimally invasive for u-rological treatment.