经尿道输尿管镜钬激光碎石术在输尿管结石患者中的应用效果及对创伤应激的影响

向军吉 赵读泽 孙华珺 刘朋

【摘要】 目的：探究與观察经尿道输尿管镜钬激光碎石术在输尿管结石患者中的应用效果及对创伤应激的影响。方法：选取2018年1月-2020年5月82例输尿管结石患者，根据随机数字表法将其分为对照组和观察组，每组41例。对照组采用体外冲击波碎石，观察组采用经尿道输尿管镜钬激光碎石术治疗。比较两组并发症发生情况、术后2、4周的疗效、术前及术后1、3 d的应激激素（Cor、ALD、NE）及炎性应激指标（IL-1β、IL-6、TNF-α）。结果：术后2、4周，观察组总有效率均高于对照组，差异均有统计学意义（P<0.05）。观察组的并发症发生率低于对照组，差异有统计学意义（P<0.05）。术前，两组Cor、ALD、NE、IL-1β、IL-6、TNF-α比较，差异均无统计学意义（P>0.05）。术后1 d，两组Cor、ALD、NE、IL-1β、IL-6、TNF-α均高于术前和术后3 d，差异均有统计学意义（P<0.05）。术后1、3 d，两组Cor、ALD、NE、IL-1β、IL-6、TNF-α比较，差异均无统计学意义（P>0.05）。结论：经尿道输尿管镜钬激光碎石术在输尿管结石患者中的应用效果相对较好，安全性较高，且其对创伤应激的控制效果也值得肯定，因此在输尿管结石患者中的应用价值较高。

【关键词】 经尿道输尿管镜钬激光碎石术 输尿管结石 创伤应激

Application Effect of Transurethral Ureteroscope Holmium Laser Lithotripsy in Patients with Ureteral Calculi and Influence for Traumatic Stress/XIANG Junji， ZHAO Duze， SUN Huajun， LIU Peng. //Medical Innovation of China， 2021， 18（27）： 0-057

[Abstract] Objective： To investigate and observe the application effect of transurethral ureteroscope holmium laser lithotripsy in patients with ureteral calculi and influence for traumatic stress. Method： A total of 82 patients with ureteral calculi from January 2018 to May 2020 were selected， and they were divided into control group and observation group according to random number table method， 41 cases in each group. The control group was treated with extracorporeal shock wave lithotripsis， and the observation group was treated with transurethral ureteroscope holmium laser lithotripsy. The incidence of complications， efficacy 2 and 4 weeks after surgery， stress hormone （Cor， ALD， NE） and inflammatory stress indexes （IL-1β， IL-6， TNF-α） before surgery and 1， 3 d after surgery were compared between two groups. Result： 2 and 4 weeks after surgery， the total effective rate of observation group were higher than those of control group， the differences were statistically significant （P<0.05）. The incidence of complications of the observation group was lower than that of the control group， the difference was statistically significant （P<0.05）. Before surgery， there were no significant differences in Cor， ALD， NE， IL-1β， IL-6 and TNF-α between two groups （P>0.05）. 1 d after surgery， Cor， ALD， NE， IL-1β， IL-6 and TNF-α of both groups were higher than those before surgery and 3 d after surgery， the differences were statistically significant （P<0.05）. 1， 3 d after surgery， there were no significant differences in Cor， ALD， NE， IL-1β， IL-6 and TNF-α between two groups （P>0.05）. Conclusion： The application effect of transurethral ureteroscope holmium laser lithotripsy in patients with ureteral calculi is relatively good， with high safety， and its control effect on traumatic stress is also worthy of affirmation， so it is of high application value in patients with ureteral calculi.

[Key words] Transurethral ureteroscope holmium laser lithotripsy Ureteral calculi Traumatic stress

First-author’s address： Suzhou Medical Treatment Area， No.904 Hospital of Joint Service Support Force of Chinese People’s Liberation Army， Suzhou 215000， China

doi：10.3969/j.issn.1674-4985.2021.27.014

输尿管结石在临床多见，患者可表现出腰部绞痛、血尿、肾积水及其他多方面的症状体征，对患者造成的不适感极为突出，严重影响其生存质量及状态。临床中与输尿管结石相关的诊治研究众多，而不同的治疗方式在结石清除效果及机体创伤控制方面存在一定的差异[1-2]。同时上述两大方面也是输尿管结石治疗的重点评估方面。近年来，临床中采用经尿道输尿管镜治疗输尿管结石的研究不断增多，但是对其结石清除效果及创伤控制方面的作用研究相对不足，且研究之间的结果存在较大争议，尤其是对机体不良影响的控制效果研究空间较大[3-5]。……