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目的研究后腹腔镜输尿管切开取石术治疗复杂输尿管上段结石的有效性与安全性。方法将2013年5月至2014年6月贵州省人民医院收治的复杂输尿管上段结石130例患者纳入研究对象,采用随机数字表法分为观察组和对照组,各65例;观察组接受后腹腔镜输尿管切开取石术,对照组接受开放手术,比较两组的手术情况、炎性反应及应激反应。结果 (1)手术情况:观察组手术时间明显高于对照组[(102.01±18.45)min vs(78.54±8.36)min(P<0.05)],术中出血量、术后引流量、肛门排气时间、卧床时间均明显低于对照组[(26.92±4.52)ml vs(44.46±6.41)ml、(12.41±1.75)ml vs(22.37±3.04)ml,(1.03±0.13)d vs(1.72±0.20)d、(2.74±0.42)d vs(4.29±0.63)d(P<0.05)];(2)炎性反应:观察组患者血清中白细胞介素-1、白细胞介素-6的含量低于对照组[(547.32±65.24)pg/ml vs(616.45±72.12)pg/ml、(242.25±38.36)pg/ml vs(312.45±47.56)pg/ml(P<0.05)];(3)应激反应:观察组患者血清中皮质醇、去甲肾上腺素、肾上腺素的含量低于对照组[(154.42±19.42)ng/ml vs(203.29±38.73)ng/ml、(119.31±13.24)ng/ml vs(155.57±18.57)ng/ml、(132.92±17.42)ng/ml vs(165.34±22.33)ng/ml(P<0.05)]。结论后腹腔镜输尿管切开取石术有助于减小手术创伤,缓解炎性反应、应激反应,促进术后恢复。
Objective To study the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy in the treatment of complicated upper ureteral calculi. Methods A total of 130 patients with complex ureteral calculi treated in Guizhou Provincial People’s Hospital from May 2013 to June 2014 were included in the study. The patients were divided into observation group and control group by random number table. Each group received 65 cases. Ureteroscopic ureterolithotomy, the control group underwent open surgery, the two groups were compared the surgical conditions, inflammatory reactions and stress response. Results (1) Surgical operation: The operation time in the observation group was significantly higher than that in the control group [(102.01 ± 18.45) min vs (78.54 ± 8.36) min, P <0.05), intraoperative blood loss, postoperative drainage, Time and bed time were significantly lower than those in the control group [(26.92 ± 4.52) ml vs (44.46 ± 6.41) ml, (12.41 ± 1.75) ml vs (22.37 ± 3.04) ml vs (1.03 ± 0.13) d vs (1.72 ± 0.20 (2.74 ± 0.42) d vs (4.29 ± 0.63) d respectively (P <0.05); (2) Inflammatory reaction: The content of interleukin-1 and interleukin-6 in serum of the observation group was lower than The control group [(547.32 ± 65.24) pg / ml vs (616.45 ± 72.12) pg / ml, (242.25 ± 38.36) pg / ml vs. (312.45 ± 47.56) pg / Response: The levels of serum cortisol, norepinephrine and epinephrine in the observation group were lower than those in the control group [(154.42 ± 19.42) ng / ml vs (203.29 ± 38.73) ng / ml, (119.31 ± 13.24) ng / ml vs (155.57 ± 18.57) ng / ml, (132.92 ± 17.42) ng / ml vs (165.34 ± 22.33) ng / ml, P <0.05). Conclusions Retroperitoneal laparoscopic ureterolithotomy is helpful to reduce trauma, relieve inflammatory reaction and stress response, and promote postoperative recovery.