摘要
目的探讨经后腹腔镜输尿管切开取石术(RLU)与尿道输尿管镜碎石术(URL)对输尿管上段结石患者的肾功能、氧化应激及免疫球蛋白的影响。方法回顾性选取2017年6月至2020年4月义乌市中心医院收治的输尿管上段结石患者78例的临床资料。根据手术方式的不同分为URL组(n=38,URL治疗)和RLU组(n=40,RLU治疗),比较两组患者肾功能[肌酐(Scr)、尿素氮(BUN)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)]、氧化应激[超氧化物歧化酶(SOD)、丙二醛(MDA)]、免疫球蛋白[免疫球蛋白A(IgA)、免疫球蛋白M(IgM)、免疫球蛋白G(IgG)]及并发症情况。结果RLU组术后1 d Scr(79.59±6.02)μmol/L、BUN(6.93±1.17)mmol/L、NGAL(4.78±0.61)μg/L,均低于URL组[Scr(86.98±8.27)μmol/L、BUN(7.62±1.24)mmol/L、NGAL(6.03±0.79)μg/L](t=4.53、2.53、7.85,P<0.001、P=0.014、P<0.001)。RLU组术后1 d IgA(1.94±0.25)g/L、IgM(1.55±0.24)g/L、IgG(6.59±1.25)g/L,均低于URL组[IgA(2.38±0.23)g/L、IgM(1.82±0.27)g/L、IgG(7.89±1.36)g/L](t=8.08、4.67、4.40,P<0.001、0.001、0.001)。RLU组术后1 d的MDA(7.49±1.26)mmol/L,低于URL组的(8.93±1.38)mmol/L(t=4.817,P<0.001)。RLU组术后1 d的SOD(72.18±7.55)mg/L,高于URL组的(63.49±6.69)mg/L(t=5.37,P<0.001)。URL组术后并发症发生率为15.79%(6/38),RLU组术后并发症发生率为7.50%(3/40),两组术后并发症发生率比较,差异无统计学意义(χ^(2)=1.31,P=0.252)。结论与URL相比,RLU治疗输尿管上段结石,对患者肾功能、氧化应激及免疫球蛋白的影响明显更轻,且不增加并发症发生率。
Objective To explore the effects of retroperitoneal laparoscopic ureterolithotomy(RLU)and urethral ureteroscopic lithotripsy(URL)on renal function,oxidative stress,and immunoglobulin levels in patients with upper ureteral calculi.Methods The clinical data of 78 patients with upper ureteral calculi,who received treatment in Yiwu Central Hospital from June 2017 to April 2020,were collected for this study.The patients were divided into URL group(n=38,URL treatment)and RLU group(n=40,RLU treatment)according to different surgical methods.Renal function(creatinine,urea nitrogen,neutrophil gelatinase-associated lipocalin),oxidative stress(superoxide dismutase,malondialdehyde),immunoglobulin(Ig)(IgA,IgM,IgG),and complications were compared between the two groups.Results At 1 day after surgery,creatinine,urea nitrogen,neutrophil gelatinase-associated lipocalin in the RLU group were(79.59±6.02)μmol/L,(6.93±1.17)mmol/L,(4.78±0.61)μg/L,respectively,which were significantly lower than those in the URL group[(86.98±8.27)μmol/L,(7.62±1.24)mmol/L,(6.03±0.79)μg/L,t=4.53,2.53,7.85,P<0.001,P=0.014,P<0.001).At 1 day after surgery,IgA,IgM,and IgG in the RLU group were(1.94±0.25)g/L,(1.55±0.24)g/L,(6.59±1.25)g/L,respectively,which were significantly lower than those in the URL group[(2.38±0.23)g/L,(1.82±0.27)g/L,(7.89±1.36)g/L,t=8.08,4.67,4.40,P<0.001,0.001,0.001].At 1 day after surgery,malondialdehyde level was significantly lower in the RLU group than in the URL group[(7.49±1.26)mmol/L vs.(8.93±1.38)mmol/L,t=4.817,P<0.001].At 1 day after surgery,superoxide dismutase level was significantly higher in the RLU group than in the URL group[(72.18±7.55)mg/L vs.(63.49±6.69)mg/L,t=5.37,P<0.001).There was no significant difference in the incidence of postoperative complications[15.79%(6/38)vs.7.50%(3/40),χ^(2)=1.31,P=0.252].Conclusion RLU for the treatment of upper ureteral calculi has fewer effects on renal function,oxidative stress,and immunoglobulin level in patients with upper ureteral calculi compared with URL and does not increase the incidence of complications.
作者
楼正达
骆俊峰
王伟强
Lou Zhengda;Luo Junfeng;Wang Weiqiang(Department of Urology Surgery,Yiwu Central Hospital,Yiwu 322000,Zhejiang Province,China)
出处
《中国基层医药》
CAS
2022年第1期82-86,共5页
Chinese Journal of Primary Medicine and Pharmacy
基金
浙江省金华市科学技术研究计划项目(20194136)。
关键词
输尿管结石
经尿道输尿管镜碎石术
后腹腔镜输尿管切开取石术
肾功能
氧化应激
免疫球蛋白
治疗结果
手术后并发症
Ureteral calculi
Transurethral ureteroscopic lithotripsy
Retroperitoneal laparoscopic ureterolithotomy
Renal function
Oxidative stress
Immunoglobulin
Treatment outcome
Postoperative complications
