The Influence On Systemic Stress Response And Peripheral Blood T Lymphocyte Subsets After Simultaneous Flexible Ureterorenoscope Lithotripsy Of Bilateral Upper Urinary Tract Stones

Objective The serum cortisol,epinephrine,norepinephrine and T lymphocyte subsets changes in perioperative period of bilateral/unilateral upper urinary tract stone patients that undergoing the flexible ureteroscopic holmium laser lithotripsy were detected.To evaluate the feasibility and safety of simultaneous flexible ureteroscopy in the treatment of bilateral upper urinary tract calculi from the point of view of systemic stress response and immune function changes.Methods From December 2015 to December 2017,the patients in our hospital that underwent flexible ureteroscopic Ho:YAG laser lithotripsy were included in this study.including 29 patients with bilateral upper urinary tract calculi(group A,n=29),18 males and 11 females,with an average age of 45.3 ±13.6 years(from 21 to 73 years);31 patients with unilateral upper ureteral calculi(group B,n=31),21 males and 10 females,with an average of 43.5 ±15.6 years(from 29 to 68 years).The probability of complications associated with surgery of patients were less than 50%(evaluated the by POSSUM scoring system).Urinary track CT was performed to assess the stone load(sum of maximum diameter)before operation.All patients underwent flexible ureteroscopic Ho:YAG stimulation and intravenous-inhalation combined anesthesia.The ureteral stents were placed for 4-12 weeks after operation.KUB or CT was performed after 1 month to evaluate the stone removal rate.The peripheral blood samples were collected from the patients before and after operation on the first,third and fifth day.Elisa method was used to detect cortisol,adrenalin and noradrenalin.Flow cytometry was used to detect CD3+,CD4+,CD8+ T lymphocytes and calculate the CD4+/CD8+ T lymphocytes ratio.The operation time,length of stay and complications were recorded.Results(1)Patients in group A(n=29),the average operation time was 108.3 + 11.5 min,stone clearance rate was 89.7%(26/29),postoperative complications rate was 13.8%(4/29);patients in group B(n=31),the average operation time was 86.9 + 13.3min,stone clearance rate was 88.6%(31/35),postoperative complications rate was 16.1%(5/31).All the postoperative complications of the disease were improved after symptomatic treatment.The differences of sex ratio,age,stone clearance rate and postoperative complications ratio between those two groups are no significant statistically difference(p>0.05).The differences of operation time and mean stone load between those two groups are statistically significant(p<0.05).(2)There were no significant differences between those two groups in expression of E,NE and Cor in peripheral blood during perioperative period(P > 0.05).The expression of indexes above increasing in both two groups on the 1st day after operation than before operation,the difference is statistically significant,the differences are statistically significant(p<0.05).On 3rd day after operation,the expression of the above indexes in the two groups returned to their preoperative level,the difference was no significant(P > 0.05).(3)The differences of CD3+,CD4+,CD8+ T lymphocytes count and CD4+/CD8+ T lymphocytes ratio between two groups were not statistically significant(p>0.05).Compared with preoperative level,the CD3+,CD4+ T lymphocytes count and CD4+/CD8+ T lymphocytes ratio of each group getting lower on the 1st and 3rd day after operation,the differences are statistically significant(p<0.05).Compared with the 1st day after operation,the level of indexes above on 3rd day after operation increased,the differences are statistically significant(p<0.05).Compared with preoperative level,the level of indexes above were not statistically significant(p>0.05)on 5th day after operation.Conclusion The perioperative systemic stress response of bilateral/unilateral upper urinary calculi patients that undertook the flexible ureteroscopic Ho:YAG laser lithotripsy reflects on transient adrenal dysfunction and immunosuppression.There was no difference in the degree of change and recovery time between the two groups.On the premise of full preoperative evaluation,using flexible ureteroscope to treat bilateral upper urinary tract calculi at the same time does not increase the risk of systemic stress and immunosuppressive in perioperative period.It is feasible,safe and effective to perform simultaneously flexible ureteroscopic Ho:YAG laser lithotripsy for bilateral upper urinary tract calculi patients.