2019 年第 3 期 第 14 卷

侧卧体位微创治疗输尿管上段结石的效果及术中应用小剂量地塞米松对患者C反应蛋白和降钙素原水平的影响

Therapeutic effect of minimally invasive surgery on upper ureteral calculi in lateral position and effect of intraoperative use of low dose dexamethasone on levels of C-reactive protein and procalcitonin

作者：沈勇虎杨增士洪景范卓红兵叶宁

英文作者：

单位：528415广东省中山市小榄人民医院泌尿外科

英文单位：

关键词：输尿管上段结石；侧卧体位；微创手术；C反应蛋白；降钙素原

英文关键词：

• 摘要：

• 【摘要】目的    探究侧卧体位微创治疗输尿管上段结石的效果，同时分析术中应用小剂量地塞米松对患者C反应蛋白和降钙素原水平的影响。方法    回顾性分析2016年1月至2018年1月在广东省中山市小榄人民医院泌尿外科接受侧卧体位微创方法治疗的261例输尿管上段结石患者的临床资料，分为3组：输尿管镜气压弹道碎石术组（PL组，123例）、输尿管镜钬激光碎石术组（LL组，95例）和输尿管镜气压弹道碎石术联合经皮肾镜碎石取石术组（PL联合PCNL组，43例）。分析3组患者的临床治疗效果及术中给予小剂量地塞米松（5 mg）对患者术后血清C反应蛋白和降钙素原水平的影响。结果    PL联合PCNL组患者的碎石成功率、清石率、并发症发生率、血红蛋白下降水平均明显高于PL组和LL组［100.0%（43/43）比94.3%（116/123）、98.9%（94/95），100.0%（43/43）比93.5%（115/123）、96.8%（92/95），9.3%（4/43）比3.3%（4/123）、3.2%（3/95），（12.9±5.4）g/L比（5.8±2.2）、（6.2±3.4）g/L］，手术时间和术后住院天数也明显延长［（48±8）min比（40±9）、（42±8）min，（8.6±1.6）d比（2.8±0.6）、（2.7±1.0）d］，差异均有统计学意义（均P＜0.05）。3组患者术后C反应蛋白和降钙素原相对水平均明显降低，且PL联合PCNL组明显低于PL组和LL组［（0.31±0.06）比（0.40±0.07）、（0.37±0.09），（0.32±0.05）比（0.41±0.08）、（0.38±0.06）］，差异均有统计学意义（均P＜0.05）。结论    侧卧体位微创治疗输尿管上段结石具有较好的临床效果，且术中应用小剂量地塞米松能有效降低患者血清C反应蛋白和降钙素原水平。

• 【Abstract】Objective    To analyze the effect of minimally invasive surgery on patients with upper ureteral calculi in lateral position and the effect of intraoperative use of low dose dexamethasone on serum levels of C-reactive protein and procalcitonin. Methods    Clinical data of 261 patients with upper ureteral calculi treated by lateral position minimally invasive surgery from January 2016 to January 2018 in Xiaolan People′s Hospital of Zhongshan were retrospectively analyzed. The patients were divided into three groups: ureteroscope pneumatic lithotripsy group(PL group, 123 cases), ureteroscope holmium laser lithotripsy group(LL group, 95 cases) and PL combined with percutaneous nephroscope lithotripsy (PCNL) group (43 cases). Dexamethasone 5 mg was used in all patients during surgery. Surgical effect and postoperative levels of serum C-reactive protein and procalcitonin were analyzed. Results    Success rate of lithotripsy, calculi-removal rate, complication rate, decrease of hemoglobin level were significantly higher, operation time and postoperative hospital stay time were significantly longer in PL combined with PCNL group than those in PL group and LL group［100.0%（43/43） vs 94.3%（116/123）, 98.9%（94/95）; 100.0%（43/43） vs 93.5%（115/123）, 96.8%（92/95）; 9.3%（4/43） vs 3.3%（4/123）, 3.2%（3/95）; （12.9±5.4）g/L vs （5.8±2.2）,（6.2±3.4）g/L; （48±8）min vs （40±9）,（42±8）min; （8.6±1.6）d vs （2.8±0.6）,（2.7±1.0）d］（all P＜0.05）. Serum levels of C-reactive protein and procalciton significantly decreased after surgery and the levels in PL combined with PCNL group were significantly lower than those in PL group and LL group［（0.31±0.06） vs （0.40±0.07）,（0.37±0.09）; （0.32±0.05） vs （0.41±0.08）,（0.38±0.06）］（all P＜0.05）. Conclusion    Lateral position minimally invasive surgery has a good clinical effect on upper ureteral calculi and low dose of dexamethasone can effectively reduce serum levels of C-reactive protein and procalcitonin.