后腹腔镜输尿管切开取石术与经输尿管镜取石术治疗老年上尿路结石患者的疗效及对血清ET—1、PGE2、PGF2α的影响(1)
【摘要】 目的：探讨后腹腔镜输尿管切开取石术(RLU)与经输尿管镜取石术(URL)治疗老年上尿路结石患者的效果及对血清超敏C反应蛋白(hs-CRP)、内皮素(ET-1)、前列腺素E2(PGE2)、PGF2α等指标的影响。方法：将2015年4月-2017年7月因上尿路结石于本院行手术治疗的90例患者纳入研究，并随机分为对照组与观察组，每组各45例。对照组采用URL术治疗，观察组采用RLU术，比较两组患者术前及手术5 d后hs-CRP及ET-1改善情况，PGE2、PGF2α等疼痛介质水平改善情况，及两组临床疗效差异。结果：观察组ET-1及hs-CRP等指标水平低于对照组，两组比较差异均有统计学意义(P<0.05)；术后第5天观察组PGE2、PGF2α水平低于对照组(P<0.05)；观察组一次性结石清除率97.78%高于对照组77.78%，两组比较差异有统计学意义(P<0.05)；观察组并发症发生率2.22%低于对照组17.78%，两组比较差异有统计学意义(P<0.05)。结论：采用RLU治疗老年上尿路结石效果显著，创伤小，可降低疼痛介质，一次性结石清除率高，值得推广。
【关键词】 RLU； URL； 老年； 上尿路结石； ET-1； 疼痛介质
【Abstract】 Objective：To investigate the retroperitoneal laparoscopic ureterolithotomy(RLU) and ureteroscopic lithotomy (URL) treatment of elderly patients with upper urinary calculi and on serum high sensitivity C reactive protein (hs-CRP)，endothelin (ET-1) and prostaglandin E2(PGE2)，PGF2α index.Method：From April 2015 to July 2017，90 patients with upper urinary tract calculi underwent surgical treatment in our hospital were included in the study and randomly divided into two groups，45 cases in each group.The control group was given URL treatment，the observation group was given RLU operation，the improve situation of hs-CRP and ET-1 before and 5 days after surgery of two groups were compared，two groups of PGE2，PGF2α and other pain medium levels to improve the situation were compared，the clinical curative effects of two groups were compared.Result：The levels of ET-1 and hs-CRP in observation group were lower than those of control group，the differences were statistically significant(P<0.05).After fifth days，the levels of PGE2 and PGF2α observation group were lower than those of control group(P<0.05). The one-time stone clearance rate in observation group was 97.78% higher than that of the control group 77.78%，the difference was statistically significant the observation group(P<0.05).The incidence of complications in observation group was 2.22% lower than the control group of 17.78%，the difference was statistically significant(P<0.05).Conclusion：RLU is effective in the treatment of elderly patients with upper urinary tract calculi.It has advantages of less trauma，lower pain medium，high one-time stone clearance rate，and it is worthy of promotion.
【Key words】 RLU； URL； Elderly； Upper urinary calculi； ET-1； Medium pain
First-author’s address：The Fourth Affiliated Hospital of Nanchang University，Nanchang 330000，China
doi：10.3969/j.issn.1674-4985.2017.34.011
上尿路結石时临床常见的结石类型，包括上段输尿管结石和肾结石，以尿痛、排尿中断、血尿为主要表现。及时清除结石是治疗上尿路结石的关键，但内科保守治疗往往效果有限，因此手术是仍本病的首选方案[1]。传统开腹手术操作简单，可在直视下操作，但存在创伤大，手术并发症大的弊端。近年来随着微创技术的不断发展，后腹腔镜输尿管切开取石术(RLU)及经输尿管镜取石术(URL)等微创手术逐渐被应用于临床，已取代开放手术而成为本病的主要治疗方案[2-3]。既往认为URL具有创伤小的优势，钬激光的应用碎石效果好，但仍存在结石残留率高的弊端，并且在输尿管上段结石治疗过程中可因结石上移而影响手术进行，降低手术成功率[4]。将2015年4月-2017年7月因上尿路结石于本院行手术治疗的90例患者纳入研究，对RLU与URL的疗效进行观察，现报道如下。, 百拇医药(谢梅茂 傅龙龙 王忠军 胡映秋 王晓荣)
【关键词】 RLU； URL； 老年； 上尿路结石； ET-1； 疼痛介质
【Abstract】 Objective：To investigate the retroperitoneal laparoscopic ureterolithotomy(RLU) and ureteroscopic lithotomy (URL) treatment of elderly patients with upper urinary calculi and on serum high sensitivity C reactive protein (hs-CRP)，endothelin (ET-1) and prostaglandin E2(PGE2)，PGF2α index.Method：From April 2015 to July 2017，90 patients with upper urinary tract calculi underwent surgical treatment in our hospital were included in the study and randomly divided into two groups，45 cases in each group.The control group was given URL treatment，the observation group was given RLU operation，the improve situation of hs-CRP and ET-1 before and 5 days after surgery of two groups were compared，two groups of PGE2，PGF2α and other pain medium levels to improve the situation were compared，the clinical curative effects of two groups were compared.Result：The levels of ET-1 and hs-CRP in observation group were lower than those of control group，the differences were statistically significant(P<0.05).After fifth days，the levels of PGE2 and PGF2α observation group were lower than those of control group(P<0.05). The one-time stone clearance rate in observation group was 97.78% higher than that of the control group 77.78%，the difference was statistically significant the observation group(P<0.05).The incidence of complications in observation group was 2.22% lower than the control group of 17.78%，the difference was statistically significant(P<0.05).Conclusion：RLU is effective in the treatment of elderly patients with upper urinary tract calculi.It has advantages of less trauma，lower pain medium，high one-time stone clearance rate，and it is worthy of promotion.
【Key words】 RLU； URL； Elderly； Upper urinary calculi； ET-1； Medium pain
First-author’s address：The Fourth Affiliated Hospital of Nanchang University，Nanchang 330000，China
doi：10.3969/j.issn.1674-4985.2017.34.011
上尿路結石时临床常见的结石类型，包括上段输尿管结石和肾结石，以尿痛、排尿中断、血尿为主要表现。及时清除结石是治疗上尿路结石的关键，但内科保守治疗往往效果有限，因此手术是仍本病的首选方案[1]。传统开腹手术操作简单，可在直视下操作，但存在创伤大，手术并发症大的弊端。近年来随着微创技术的不断发展，后腹腔镜输尿管切开取石术(RLU)及经输尿管镜取石术(URL)等微创手术逐渐被应用于临床，已取代开放手术而成为本病的主要治疗方案[2-3]。既往认为URL具有创伤小的优势，钬激光的应用碎石效果好，但仍存在结石残留率高的弊端，并且在输尿管上段结石治疗过程中可因结石上移而影响手术进行，降低手术成功率[4]。将2015年4月-2017年7月因上尿路结石于本院行手术治疗的90例患者纳入研究，对RLU与URL的疗效进行观察，现报道如下。, 百拇医药(谢梅茂 傅龙龙 王忠军 胡映秋 王晓荣)