目的 探讨无管化微创PCNL（经皮肾镜取石术）治疗嵌顿性输尿管上段结石的效果。方法 将中山大学附属第一医院惠亚医院2019年12月—2021年12月收治的95例嵌顿性输尿管上段结石患者按照随机数字表法分组,给予对照组47例患者经尿道输尿管镜碎石术（TURL）治疗、观察组48例患者无管化微创PCNL治疗,观察两组手术一般状况、血清学指标、肾脏血流动力学以及并发症发生情况。结果 观察组手术时间、术后血尿以及住院时间均短于对照组,观察组术中出血量少于对照组,观察组结石清除率高于对照组（P<0.05）;术后1 d观察组肾损伤分子-1（KIM-1）、中性粒细胞明胶相关脂脂质运载蛋白（NGAL）以及胱抑素C（Cys-C）水平低于对照组（P<0.05）;两组肾动脉收缩期血流速度（Vs）以及舒张末期血流速度（Vd）对比差异无统计学意义（P>0.05）;观察组并发症发生率（4.16%）低于对照组（19.15%）（P<0.05）。结论 无管化微创PCNL可改善嵌顿性输尿管上段结石手术一般状况,减轻患者肾脏损伤,提高结石清除率,不影响肾脏血流,且并发症更少。
Objective To explore the effect of tubeless minimally invasive（percutaneous nephrolithotomy,PCNL）in the treatment of impacted upper ureteral stones．Methods A total of 95 patients with impacted upper ureteral stones admitted to our hospital from December 2019 to December 2021 were grouped according to the random number table method．Control group of 47 cases were treated with transurethral ureteroscopy lithotripsy（TURL）,48 patients in the observation group were given tubeless minimally invasive PCNL treatment．The general surgical conditions,serological indicators,renal hemodynamics and complications of the two groups were observed．Results The operation time,postoperative hematuria and hospitalization time of the observation group were shorter than those of the control group,the intraoperative bleeding volume of the observation group was less than that of the control group,and the stone free rate of the observation group was higher than that of the control group（P<0.05）．One day after surgery,the levels of kidney injury molecule-1（KIM-1）,lipocalin（NGAL）and cystatin C（Cys-C）in the observation group were lower than those in the control group（P<0.05）;the renal artery systolic blood flow velocity（Vs）and end-diastolic blood flow velocity（Vd）had no statistical significance（P>0.05）;the incidence of complications in the observation group（4.16%）was lower than that in the control group（19.15%）（P<0.05）．Conclusions Tubeless minimally invasive PCNL can improve the general conditions of surgery,reduce kidney damage,increase stone free rate,does not affect renal blood flow,and has fewer complications．
目的 研究输尿管镜下钬激光碎石术治疗输尿管结石疗效及对氧化应激指标的影响。方法 选取我院2016年3月—2017年4月间收治的输尿管结石患者60例,随机将其分为对照组和观察组,每组各30例。观察组接受输尿管钬激光碎石术治疗,对照组接受传统开放手术治疗。比较两组手术前后白细胞介素-10(IL-10)、C反应蛋白(CRP)、白细胞(WBC)等炎性因子以及皮质醇(Cor)、丙二醛(MDA)、超氧化物歧化酶(SOD)等氧化应激指标水平,同时比较两组碎石情况。结果 观察组手术时间、住院天数低于对照组,结石排净率高于对照组(P<0.05);术后,观察组IL-10、CRP、WBC高于对照组(P<0.05);观察组Cor、MDA低于对照组,而SOD高于对照组(P<0.05)。结论 输尿管镜下钬激光碎石术治疗输尿管结石疗效显著,能够抑制炎性因子,减轻应激反应,促进患者疾病康复,值得临床推广。
Objective To study the effect of ureteroscopic holmium laser lithotripsy in the treatment of ureteral calculi and its effect on oxidative stress. Methods Sixty patients with ureteral calculi admitted to our hospital from March 2016 to April 2017 were randomly divided into control group and observation group, with 30 cases in each group. The observation group received ureteroscopic holmium laser lithotripsy and the control group received conventional open surgery. We compared inflammatory factors such as interleukin-10 (IL-10), C-reactive protein (CRP), and white blood cells (WBC) before and after surgery, as well as cortisol (Cor), malondialdehyde (MDA), and superoxide dismutase (SOD) and other levels of oxidative stress indicators, while comparing the two groups of debris. Results The operation time and hospitalization days in the observation group were lower than those in the control group. The stone removal rate was higher than that in the control group (P<0.05). After operation, the IL-10, CRP and WBC in the observation group were higher than those in the control group (P< 0.05). Cor and MDA in the observation group were lower than the control group, and SOD was higher than the control group (P<0.05). Conclusion Ureteroscopic holmium laser lithotripsy is effective in the treatment of ureteral calculi. It can inhibit inflammatory factors, reduce stress response, and promote the recovery of patients' diseases. It is worthy of clinical promotion.
目的 探讨无管化微创PCNL（经皮肾镜取石术）治疗嵌顿性输尿管上段结石的效果。方法 将中山大学附属第一医院惠亚医院2019年12月—2021年12月收治的95例嵌顿性输尿管上段结石患者按照随机数字表法分组，给予对照组47例患者经尿道输尿管镜碎石术（TURL）治疗、观察组48例患者无管化微创PCNL治疗，观察两组手术一般状况、血清学指标、肾脏血流动力学以及并发症发生情况。结果 观察组手术时间、术后血尿以及住院时间均短于对照组，观察组术中出血量少于对照组，观察组结石清除率高于对照组（P＜0.05）；术后1 d观察组肾损伤分子-1（KIM-1）、中性粒细胞明胶相关脂脂质运载蛋白（NGAL）以及胱抑素C（Cys-C）水平低于对照组（P＜0.05）；两组肾动脉收缩期血流速度（Vs）以及舒张末期血流速度（Vd）对比差异无统计学意义（P＞0.05）；观察组并发症发生率（4.16%）低于对照组（19.15%）（P＜0.05）。结论 无管化微创PCNL可改善嵌顿性输尿管上段结石手术一般状况，减轻患者肾脏损伤，提高结石清除率，不影响肾脏血流，且并发症更少。
Objective To explore the effect of tubeless minimally invasive（percutaneous nephrolithotomy，PCNL）in the treatment of impacted upper ureteral stones．Methods A total of 95 patients with impacted upper ureteral stones admitted to our hospital from December 2019 to December 2021 were grouped according to the random number table method．Control group of 47 cases were treated with transurethral ureteroscopy lithotripsy（TURL），48 patients in the observation group were given tubeless minimally invasive PCNL treatment．The general surgical conditions，serological indicators，renal hemodynamics and complications of the two groups were observed．Results The operation time，postoperative hematuria and hospitalization time of the observation group were shorter than those of the control group，the intraoperative bleeding volume of the observation group was less than that of the control group，and the stone free rate of the observation group was higher than that of the control group（P＜0.05）．One day after surgery，the levels of kidney injury molecule-1（KIM-1），lipocalin（NGAL）and cystatin C（Cys-C）in the observation groupwere lower than those in the control group（P＜0.05）；the renal artery systolic blood flow velocity（Vs）and end-diastolic blood flow velocity（Vd）had no statistical significance（P＞0.05）；the incidence of complications in the observation group（4.16%）was lower than that in the control group（19.15%）（P＜0.05）．Conclusions Tubeless minimally invasive PCNL can improve the general conditions of surgery，reduce kidney damage，increase stone free rate，does not affect renal blood flow，and has fewer complications．
