输尿管镜下钬激光与气压弹道碎石术对老年输尿管上段结石患者应激反应及碎石效果的比较
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摘要
目的探讨输尿管镜下钬激光碎石术(HLL)与气压弹道碎石术(PL)对老年输尿管上段结石(UUC)患者应激反应及碎石效果的影响。方法入选2016年6月至2018年6月宝鸡市人民医院泌尿外科老年UUC患者100例,随机数表法分为HLL组和PL组,每组50例,比较2组患者手术情况、碎石效果、术后皮质醇(Cor)和促肾上腺皮质激素(ACTH)水平以及并发症差异。采用SPSS 22.0统计软件对数据进行分析。组间比较采用t检验或χ~2检验。结果 HLL组相比PL组患者术中出血量[(60.97±7.02) vs (83.25±9.24) ml]、手术时间[(66.43±6.81) vs (85.43±8.72) min]、碎石时间[(31.88±3.55) vs (40.45±4.22) min]和住院时间[(6.42±1.07) vs (7.65±1.11) d]降低,术后Cor[(387.11±40.12) vs (437.13±45.43) ng/ml]和ACTH[(14.02±1.54) vs (15.71±1.68) pmol/L]水平降低,差异均具有统计学意义(P<0.001)。HLL组相比PL组患者一次碎石成功率[100%(50/50) vs 88%(44/50),P=0.012]和结石取净率[96%(48/50) vs 84%(42/50),P=0.046]高,并发症发生率低[6%(3/50) vs 20%(10/50),P=0.037]。结论输尿管镜下HLL可有效减少老年UUC患者手术创伤、并发症和应激反应的发生,且具有良好的碎石效果,值得临床推广。
Objective To investigate the effects of holmium laser lithotripsy( HLL) and pneumatic lithotripsy( PL) under uretero-scope on the stress response and lithotripsy effectiveness in elderly patients with upper ureteral calculi( UUC). Methods Totally 100 elderly patients with UUC hospitalized in our department from June 2016 to June 2018 were recruited in this study. They were equallyand randomly divided into HLL group and PL group. The effects of operation,lithotripsy,postoperative serum levels of cortisol( Cor)and adrenocorticotropic hormone( ACTH),and incidences of complications were compared between the 2 groups. SPSS statistics 22.0 was used to perform the statistical analysis. Chi-square test or Student's t test was employed for comparison between the groups. ResultsThe HLL group had significantly less volume of intraoperative bleeding [( 60. 97 ± 7. 02) vs( 83. 25 ± 9. 24) ml],shorter operativetime [( 66. 43 ± 6. 81) vs( 85. 43 ± 8. 72) min],shorter lithotripsy time [( 31. 88 ± 3. 55) vs( 40. 45 ± 4. 22) min],less length ofhospital stay [( 6. 42±1. 07) vs( 7. 65±1. 11) d],and lower serum levels of Cor [( 387. 11±40. 12) vs( 437. 13±45. 43) ng/ml]andACTH [( 14. 02±1. 54) vs( 15. 71±1. 68) pmol/L] after operation when compared with the PL group( all P< 0. 01). What' s more,the success rate of single lithotripsy [100%( 50/50) vs 88%( 44/50),P = 0. 012] and stone removal rate [96%( 48/50) vs 84%( 42/50),P= 0.046]were obviously higher,while the incidences of complications were notably lower [6%( 3/50) vs 20%( 10/50),P = 0.037] in the HLL group than the PL group. Conclusion HLL under ureteroscope effectively reduces the surgical trauma,compli-cations and stress response in the elderly patients with UUC,with good lithotripsy effect. It is worthy of further clinical promotion.
Objective To investigate the effects of holmium laser lithotripsy( HLL) and pneumatic lithotripsy( PL) under uretero-scope on the stress response and lithotripsy effectiveness in elderly patients with upper ureteral calculi( UUC). Methods Totally 100 elderly patients with UUC hospitalized in our department from June 2016 to June 2018 were recruited in this study. They were equallyand randomly divided into HLL group and PL group. The effects of operation,lithotripsy,postoperative serum levels of cortisol( Cor)and adrenocorticotropic hormone( ACTH),and incidences of complications were compared between the 2 groups. SPSS statistics 22.0 was used to perform the statistical analysis. Chi-square test or Student's t test was employed for comparison between the groups. ResultsThe HLL group had significantly less volume of intraoperative bleeding [( 60. 97 ± 7. 02) vs( 83. 25 ± 9. 24) ml],shorter operativetime [( 66. 43 ± 6. 81) vs( 85. 43 ± 8. 72) min],shorter lithotripsy time [( 31. 88 ± 3. 55) vs( 40. 45 ± 4. 22) min],less length ofhospital stay [( 6. 42±1. 07) vs( 7. 65±1. 11) d],and lower serum levels of Cor [( 387. 11±40. 12) vs( 437. 13±45. 43) ng/ml]andACTH [( 14. 02±1. 54) vs( 15. 71±1. 68) pmol/L] after operation when compared with the PL group( all P< 0. 01). What' s more,the success rate of single lithotripsy [100%( 50/50) vs 88%( 44/50),P = 0. 012] and stone removal rate [96%( 48/50) vs 84%( 42/50),P= 0.046]were obviously higher,while the incidences of complications were notably lower [6%( 3/50) vs 20%( 10/50),P = 0.037] in the HLL group than the PL group. Conclusion HLL under ureteroscope effectively reduces the surgical trauma,compli-cations and stress response in the elderly patients with UUC,with good lithotripsy effect. It is worthy of further clinical promotion.
引文
[1]邵继春,曾治军,杨剑波,等.输尿管软镜和经皮肾镜取石术对老年嵌顿性输尿管上段结石患者围术期炎性因子的影响[J].中国老年学杂志,2018,38(5):1122-1124. DOI:10.3969/j.issn.1005-9202.2018.05.038.Shao JC,Zeng ZJ,Yang JB,et al. Effect of flexible ureteroscopeand percutaneous nephrolithotomy on inflammatory factors in elderlypatients with impacted upper ureteral calculi during perioperativeperiod[J]. Chin J Gerontol,2018,38(5):1122-1124. DOI:10.3969/j.issn.1005-9202.2018.05.038.
[2]黄跃胜,黄海鹏,朱心燊.输尿管镜下钬激光碎石术对结石清除率术后并发症及临床疗效的影响[J].河北医学,2017,23(1):152-154. DOI:10.3969/j.issn.1006-6233.2017.01.051.Huang YS,Huang HP,Zhu XS. Effect of holmium laser lithotripsyunder ureteroscope on postoperative complications and clinicalcurative effect of lithotripsy[J]. Hebei Med,2017,23(1):152-154. DOI:10.3969/j.issn.1006-6233.2017.01.051.
[3] Hyams ES,Monga M,Pearle MS,et al. A prospective,multi-institutional study of flexible ureteroscopy for proximal ureteralstones smaller than 2 cm[J]. J Urol,2015,193(1):165-169.DOI:10.1016/j.juro.2014.07.002.
[4]夏桃林,张海滨,刘涛,等.钬激光与气压弹道碎石术治疗输尿管结石的临床比较[J].中国内镜杂志,2014,20(8):878-881.Xia TL,Zhang HB,Liu T,et al. The therapeutic effect com-parison of holmium laser lithotripsy and pneumatic lithotripsy forureterolith[J]. China J Endoscopy,2014,20(8):878-881.
[5] Hershkovitz E,Arafat M,Loewenthal N,et al. Combined adrenalfailure and testicular adrenal rest tumor in a patient with nicoti-namide nucleotide transhydrogenase deficiency[J]. J PediatrEndocrinol Metab,2015,28(9-10):1187-1190. DOI:10.1515/jpem-2015-0075.
[6]陈勇杰,张贤生.输尿管镜下钬激光碎石术与气压弹道碎石术治疗输尿管结石效果比较[J].山东医药,2016,56(37):87-89. DOI:10.3969/j.issn.1002-266X.2016.37.030.Chen YJ,Zhang XS. Comparison of ureteroscopic holmium laserlithotripsy and pneumatic lithotripsy in the treatment of ureteralcalculi[J]. Shangdong Med J,2016,56(37):87-89. DOI:10.3969/j.issn.1002-266X.2016.37.030.
[7] Yang B,Jiang ZP,Li YR,et al. Long-term outcome for openpreperitoneal mesh repair of recurrent inguinal hernia[J]. Int JSurg,2015,19(4):134-136. DOI:10. 1016/j. ijsu. 2015.05.029.
[8]成俊,郭小鹏,王鹏.输尿管镜钬激光碎石术治疗老年输尿管结石的疗效及对肾功能的影响[J].中国老年学杂志,2016,36(3):683-685. DOI:10.3969/j.issn.1005-9202.2016.03.076.Cheng J,Guo XP,Wang P. Therapeutic effect of ureteroscopicholmium laser lithotripsy on elderly ureteral calculi and its effect onrenal function[J]. Chin J Gerontol,2016,36(3):683-685.DOI:10.3969/j.issn.1005-9202.2016.03.076.
[9] Al-Ani A,Al-Jalham K,Ibrahim T,et al. Factors determiningrenal impairment in unilateral ureteral colic secondary to calculousdisease:a prospective study[J]. Intern Urol Nephrol,2015,47(7):1085-1090. DOI:10.1007/s11255-015-0986-0.
[10]练文勇,汪利民,徐火松,等.输尿管镜钬激光碎石术与气压弹道碎石术治疗下段输尿管结石的临床疗效分析[J].现代生物医学进展,2017,17(19):3678-3680. DOI:10. 13241/j.cnki.pmb.2017.19.019.Lian WY,Wang LM,Xu HS,et al. Clinical effects of holmium la-ser lithotripsy and pneumatic lithotripsy in the treatment of lower u-reteral calculi[J]. Prog Mod Biomed,2017,17(19):3678-3680. DOI:10.13241/j.cnki.pmb.2017.19.019.
[11] Pang K,Liu SB,Wei HB,et al. Two-micron thulium laser resec-tion of the distal ureter and bladder cuff during nephroureterectomyfor upper urinary tract urothelial carcinoma[J]. Lasers Med Sci,2014,29(2):621-627. DOI:10.1007/s10103-013-1365-7.
[12]廖尚范,卢东明,伊岱旭,等.输尿管镜下钬激光碎石与气压弹道碎石术治疗输尿管结石的效果比较[J].中国现代医生,2016,54(22):40-42.Liao SF,Lu DM,Yi DX,et al. Effect comparison of holmium laserlithotripsy and pneumatic ballistic lithotripsy in treatment ofureteral calculi through ureteroscope[J]. Chin Mod Doct,2016,54(22):40-42.
[13]杜红兵,刘文泓,杨逢生,等.输尿管镜下钬激光碎石术治疗输尿管中、下段结石的效果[J].中国当代医药,2018,25(22):88-90. DOI:10.3969/j.issn.1674-4721.2018.22.027.Du HB,Liu WH,Yang FS,et al. Effect of ureteroscopic holmiumlaser lithotripsy in the treatment of middle and lower ureteralcalculi[J]. Chin Mod Med,2018,25(22):88-90. DOI:10.3969/j.issn.1674-4721.2018.22.027.
[14]梁苏东,吕高飞,阮亚石,等.输尿管软镜碎石术与经皮肾镜碎石术对肾结石患者炎性因子、氧化应激及应激激素水平的影响[J].海南医学院学报,2017,23(20):2783-2786. DOI:10.13210/j.cnki.jhmu.20171010.003.Liang SD,Lyu GF,Ruan YS,et al. Effect of flexible ureteroscopelithotripsy and percutaneous nephrolithotomy on the levels of seruminflammatory factors, oxidative stress and stress hormone inpatients with renal calculi[J]. J Hainan Med Univ, 2017,23(20):2783-2786. DOI:10.13210/j.cnki.jhmu.20171010.003.
[15]周玉文,曹雪滨.力竭大鼠血清睾酮、皮质醇的变化及对心脏的可能影响[J].中华老年多器官疾病杂志,2013,12(9):684-685. DOI:10.3724/SP.J.1264.2013.00171.Zhou YW,Cao XB. Changes of serum testosterone and cortisol inexhausted rats and the possible influence on heart[J]. Chin J MultOrgan Dis Elderly,2013,12(9):684-685. DOI:10.3724/SP.J.1264.2013.00171.
[2]黄跃胜,黄海鹏,朱心燊.输尿管镜下钬激光碎石术对结石清除率术后并发症及临床疗效的影响[J].河北医学,2017,23(1):152-154. DOI:10.3969/j.issn.1006-6233.2017.01.051.Huang YS,Huang HP,Zhu XS. Effect of holmium laser lithotripsyunder ureteroscope on postoperative complications and clinicalcurative effect of lithotripsy[J]. Hebei Med,2017,23(1):152-154. DOI:10.3969/j.issn.1006-6233.2017.01.051.
[3] Hyams ES,Monga M,Pearle MS,et al. A prospective,multi-institutional study of flexible ureteroscopy for proximal ureteralstones smaller than 2 cm[J]. J Urol,2015,193(1):165-169.DOI:10.1016/j.juro.2014.07.002.
[4]夏桃林,张海滨,刘涛,等.钬激光与气压弹道碎石术治疗输尿管结石的临床比较[J].中国内镜杂志,2014,20(8):878-881.Xia TL,Zhang HB,Liu T,et al. The therapeutic effect com-parison of holmium laser lithotripsy and pneumatic lithotripsy forureterolith[J]. China J Endoscopy,2014,20(8):878-881.
[5] Hershkovitz E,Arafat M,Loewenthal N,et al. Combined adrenalfailure and testicular adrenal rest tumor in a patient with nicoti-namide nucleotide transhydrogenase deficiency[J]. J PediatrEndocrinol Metab,2015,28(9-10):1187-1190. DOI:10.1515/jpem-2015-0075.
[6]陈勇杰,张贤生.输尿管镜下钬激光碎石术与气压弹道碎石术治疗输尿管结石效果比较[J].山东医药,2016,56(37):87-89. DOI:10.3969/j.issn.1002-266X.2016.37.030.Chen YJ,Zhang XS. Comparison of ureteroscopic holmium laserlithotripsy and pneumatic lithotripsy in the treatment of ureteralcalculi[J]. Shangdong Med J,2016,56(37):87-89. DOI:10.3969/j.issn.1002-266X.2016.37.030.
[7] Yang B,Jiang ZP,Li YR,et al. Long-term outcome for openpreperitoneal mesh repair of recurrent inguinal hernia[J]. Int JSurg,2015,19(4):134-136. DOI:10. 1016/j. ijsu. 2015.05.029.
[8]成俊,郭小鹏,王鹏.输尿管镜钬激光碎石术治疗老年输尿管结石的疗效及对肾功能的影响[J].中国老年学杂志,2016,36(3):683-685. DOI:10.3969/j.issn.1005-9202.2016.03.076.Cheng J,Guo XP,Wang P. Therapeutic effect of ureteroscopicholmium laser lithotripsy on elderly ureteral calculi and its effect onrenal function[J]. Chin J Gerontol,2016,36(3):683-685.DOI:10.3969/j.issn.1005-9202.2016.03.076.
[9] Al-Ani A,Al-Jalham K,Ibrahim T,et al. Factors determiningrenal impairment in unilateral ureteral colic secondary to calculousdisease:a prospective study[J]. Intern Urol Nephrol,2015,47(7):1085-1090. DOI:10.1007/s11255-015-0986-0.
[10]练文勇,汪利民,徐火松,等.输尿管镜钬激光碎石术与气压弹道碎石术治疗下段输尿管结石的临床疗效分析[J].现代生物医学进展,2017,17(19):3678-3680. DOI:10. 13241/j.cnki.pmb.2017.19.019.Lian WY,Wang LM,Xu HS,et al. Clinical effects of holmium la-ser lithotripsy and pneumatic lithotripsy in the treatment of lower u-reteral calculi[J]. Prog Mod Biomed,2017,17(19):3678-3680. DOI:10.13241/j.cnki.pmb.2017.19.019.
[11] Pang K,Liu SB,Wei HB,et al. Two-micron thulium laser resec-tion of the distal ureter and bladder cuff during nephroureterectomyfor upper urinary tract urothelial carcinoma[J]. Lasers Med Sci,2014,29(2):621-627. DOI:10.1007/s10103-013-1365-7.
[12]廖尚范,卢东明,伊岱旭,等.输尿管镜下钬激光碎石与气压弹道碎石术治疗输尿管结石的效果比较[J].中国现代医生,2016,54(22):40-42.Liao SF,Lu DM,Yi DX,et al. Effect comparison of holmium laserlithotripsy and pneumatic ballistic lithotripsy in treatment ofureteral calculi through ureteroscope[J]. Chin Mod Doct,2016,54(22):40-42.
[13]杜红兵,刘文泓,杨逢生,等.输尿管镜下钬激光碎石术治疗输尿管中、下段结石的效果[J].中国当代医药,2018,25(22):88-90. DOI:10.3969/j.issn.1674-4721.2018.22.027.Du HB,Liu WH,Yang FS,et al. Effect of ureteroscopic holmiumlaser lithotripsy in the treatment of middle and lower ureteralcalculi[J]. Chin Mod Med,2018,25(22):88-90. DOI:10.3969/j.issn.1674-4721.2018.22.027.
[14]梁苏东,吕高飞,阮亚石,等.输尿管软镜碎石术与经皮肾镜碎石术对肾结石患者炎性因子、氧化应激及应激激素水平的影响[J].海南医学院学报,2017,23(20):2783-2786. DOI:10.13210/j.cnki.jhmu.20171010.003.Liang SD,Lyu GF,Ruan YS,et al. Effect of flexible ureteroscopelithotripsy and percutaneous nephrolithotomy on the levels of seruminflammatory factors, oxidative stress and stress hormone inpatients with renal calculi[J]. J Hainan Med Univ, 2017,23(20):2783-2786. DOI:10.13210/j.cnki.jhmu.20171010.003.
[15]周玉文,曹雪滨.力竭大鼠血清睾酮、皮质醇的变化及对心脏的可能影响[J].中华老年多器官疾病杂志,2013,12(9):684-685. DOI:10.3724/SP.J.1264.2013.00171.Zhou YW,Cao XB. Changes of serum testosterone and cortisol inexhausted rats and the possible influence on heart[J]. Chin J MultOrgan Dis Elderly,2013,12(9):684-685. DOI:10.3724/SP.J.1264.2013.00171.