| 王 洪,汪建平,于跃平,解 忠,金 松,李 松,郭 玺,汤 祺.输尿管软镜与经皮肾镜碎石术对≤2 cm肾结石患者血清IL-6、IL-10、Cor水平的影响及安全性研究[J].,2018,(2):284-288 |
| 输尿管软镜与经皮肾镜碎石术对≤2 cm肾结石患者血清IL-6、IL-10、Cor水平的影响及安全性研究 |
| Effectsand Safety of Flexible Ureteroscope Lithotrity and Percutaneous Nephrolithotomy on the Serum IL-6, IL-10, Cor Levels of Patients with Renal Calculus ≤2 cm |
| 投稿时间：2017-06-25 修订日期：2017-07-21 |
| DOI：10.13241/j.cnki.pmb.2018.02.020 |
| 中文关键词: 输尿管软镜 经皮肾镜 肾结石 应激反应 细胞因子 |
| 英文关键词: Flexible ureteroscope lithotrity Percutaneous nephroscope Renal calculus Stress reaction Cell factor |
| 基金项目:云南省自然科学基金项目（2010D185） |
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| 中文摘要: |
| 摘要 目的：比较输尿管软镜碎石术(FURL)与经皮肾镜碎石术(PCNL)治疗≤2 cm肾结石的疗效及对患者血清白介素(IL)-6、IL-10、皮质醇(Cor)水平的影响以及手术治疗的安全性。方法：选择2015年2月~2017年2月我院泌尿外科收治的132例直径≤2 cm的肾结石患者作为研究对象，其中行FURL治疗者72例，行PCNL治疗者60例，比较两组围手术期相关临床指标、治疗前后肾功能以及血清IL-6、IL-10、Cor水平的变化。结果：FURL组术后住院时间较PCNL组显著缩短，术后输血率较PCNL组显著降低(P<0.01)；两组手术时间、结石总清除率比较差异无统计学意义(P>0.05)。PCNL组术后24 h Hb值较术前显著降低(P<0.01)，FURL组无明显变化(P>0.05)；两组术后24 h WBC值较术前显著升高(P<0.01)，但两组组间比较无明显差异(P>0.05)。两组术后1h血清IL-6、IL-10、Cor水平均较术前显著升高，术后1、3、5d逐渐降低，FURL组术后1 h、1、3、5 d血清IL-6、IL-10、Cor水平均较PCNL组各时点显著降低(P<0.01)。两组术后6 h、1、2 d尿Kim-1及血清CysC水平均较术前显著升高(P<0.01)，FURL组尿Kim-1水平于术后3 d恢复至正常水平，PCNL组为术后5d恢复正常，PCNL组血CysC水平于术后3 d恢复至正常水平，FURL组为术后5 d恢复正常；FURL组术后2、3 d尿Kim-1水平显著低于PCNL组同时点(P<0.01)，术后1、2、3 d血CysC水平显著高于PCNL组同时点(P<0.01)。结论：FURL与PCNL治疗直径≤2cm的肾结石均能取得满意的取石效果，但FURL手术创伤更小、出血更少，术后应激反应更轻，更有利于术后机体恢复。 |
| 英文摘要: |
| ABSTRACT Objective: To compare the clinical efficacy and safety between flexible ureteroscope lithotrity (FURL) and percutaneous nephrolithotomy (PCNL) on the serum interleukin (IL)-6, IL-10, cortisol (Cor) levels of patients with renal calculus ≤2cm. Methods: 132 cases of patients with renal calculus admitted in the urinary surgery of our hospital from February 2015 to February 2017 were selected, in which 72 cases were treated by FURL and 60 cases were treated by PVNL. The clinical indexes, changes of renal function and serum IL-6, IL-10, Cor levels before and after treatment were compared between the two groups. Results: The postoperative hospital stay of FURL group was obviously shorter than that of PCNL group, and the postoperative blood transfusion rate of FURL group was significantly lower than that of PCNL group (P<0.01). No significant difference was found in terms of surgery duration and total clearance of stones between the two groups(P>0.05). The Hb value at 24h after operation were evidently decreased as compared with that before operation (P<0.01), but no significant change was found in the FURL group (P>0.05). The WBC values of both group at 24h after operation weresignificantly increased as compared with those before operation (P<0.01), but there was no statistic difference between the two groups (P>0.05). The serum IL-6, IL-10, Cor levels of both groups at 1h after operation were evidently increased as compared those before operation, and declined gradually at 1d, 3d, 5d after operation. The serum IL-6, IL-10, Cor levels of FURL group at 1h, 1d, 3d, 5d after operation were much lower than those of PCNL group at the corresponding time points (P<0.01). The urine Kim-1 and serum CysC levels of both groups at 6h, 1d, 2d after operation were significantly increased as compared with those before operation (P<0.01). The urinal Kim-1 levels of FURL group returned to normal at 3d after operation, while it took 5d for PCNL group to have it return to normal. The serum CysC level of PCNL group returned to normal at 3d after operation, while it took 5d for FURL group to have it return to normal. The levels of urine Kim-1 at 2d, 3d after operation of FURL group were significantly lower than those in PCNL group at the same time group (P<0.01), the blood CysC levels at 1, 2 and 3d after operation were significantly higher than those in PCNL group at the same time group (P<0.01). Conclusion: Both FURL and PCNL were effective in the treatment of renal calculus with a diameter ≤2cm, but FURL outperforms the other with minor operation wound, less blood loss, lighter postoperative stress reaction, and better recovery. |
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