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输尿管镜下钬激光与气压弹道碎石术对老年输尿管上段结石患者应激反应及碎石效果的比较 预览

Comparison of holmium laser lithotripsy versus pneumatic lithotripsy under ureteroscope on stress response and lithotripsy effectiveness in elderly with upper ureteral calculi
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摘要 目的探讨输尿管镜下钬激光碎石术(HLL)与气压弹道碎石术(PL)对老年输尿管上段结石(UUC)患者应激反应及碎石效果的影响。方法入选2016年6月至2018年6月宝鸡市人民医院泌尿外科老年UUC患者100例,随机数表法分为HLL组和PL组,每组50例,比较2组患者手术情况、碎石效果、术后皮质醇(Cor)和促肾上腺皮质激素(ACTH)水平以及并发症差异。采用SPSS22.0统计软件对数据进行分析。组间比较采用t检验或χ^2检验。结果HLL组相比PL组患者术中出血量[(60.97±7.02)vs(83.25±9.24)ml]、手术时间[(66.43±6.81)vs(85.43±8.72)min]、碎石时间[(31.88±3.55)vs(40.45±4.22)min]和住院时间[(6.42±1.07)vs(7.65±1.11)d]降低,术后Cor[(387.11±40.12)vs(437.13±45.43)ng/ml]和ACTH[(14.02±1.54)vs(15.71±1.68)pmol/L]水平降低,差异均具有统计学意义(P<0.001)。HLL组相比PL组患者一次碎石成功率[100%(50/50)vs88%(44/50),P=0.012]和结石取净率[96%(48/50)vs84%(42/50),P=0.046]高,并发症发生率低[6%(3/50)vs20%(10/50),P=0.037]。结论输尿管镜下HLL可有效减少老年UUC患者手术创伤、并发症和应激反应的发生,且具有良好的碎石效果,值得临床推广。 Objective To investigate the effects of holmium laser lithotripsy(HLL)and pneumatic lithotripsy(PL)under ureteroscope on the stress response and lithotripsy effectiveness in elderly patients with upper ureteral calculi(UUC).Methods Totally 100 elderly patients with UUC hospitalized in our department from June 2016 to June 2018 were recruited in this study.They were equally and randomly divided into HLL group and PL group.The effects of operation,lithotripsy,postoperative serum levels of cortisol(Cor)and adrenocorticotropic hormone(ACTH),and incidences of complications were compared between the 2 groups.SPSS statistics 22.0 was used to perform the statistical analysis.Chi-square test or Student′s t test was employed for comparison between the groups.Results The HLL group had significantly less volume of intraoperative bleeding[(60.97±7.02)vs(83.25±9.24)ml],shorter operative time[(66.43±6.81)vs(85.43±8.72)min],shorter lithotripsy time[(31.88±3.55)vs(40.45±4.22)min],less length of hospital stay[(6.42±1.07)vs(7.65±1.11)d],and lower serum levels of Cor[(387.11±40.12)vs(437.13±45.43)ng/ml]and ACTH[(14.02±1.54)vs(15.71±1.68)pmol/L]after operation when compared with the PL group(all P<0.01).What′s more,the success rate of single lithotripsy[100%(50/50)vs 88%(44/50),P=0.012]and stone removal rate[96%(48/50)vs 84%(42/50),P=0.046]were obviously higher,while the incidences of complications were notably lower[6%(3/50)vs 20%(10/50),P=0.037]in the HLL group than the PL group.Conclusion HLL under ureteroscope effectively reduces the surgical trauma,complications and stress response in the elderly patients with UUC,with good lithotripsy effect.It is worthy of further clinical promotion.
作者 康启源 张辉 毕航 李颖毅 刘双宁 KANG Qi-Yuan;ZHANG Hui;BI Hang;LI Ying-Yi;LIU Shuang-Ning(Department of Urology,Baoji People′s Hospital,Baoji 721000,China)
出处 《中华老年多器官疾病杂志》 2019年第2期127-131,共5页 Chinrse journal of Multiple Organ Diseases in the Elderly
关键词 老年人 输尿管镜 碎石术 输尿管结石 应激 aged ureteroscope lithotripsy ureteral calculus stress
作者简介 通信作者:刘双宁,E-mail:liushning@163.com
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