Effect of Ureteroscopy Combined with Lithotripsy in the Treatment of Type 2 Diabetes Mellitus Complicated with Ureteral Calculi and the Influencing Factors of Postoperative Sepsis

XU Weiwei; CAI Jianhong; LI Hongbo; MEI Guanghong

doi:10.3969/j.issn.2095-3097.2023.06.011

Abstract：Objective To investigate the effect of ureteroscopy combined with lithotripsy in the treatment of type 2 di-abetes mellitus(T2DM)complicated with ureteral calculi and the influencing factors of postoperative sepsis.Methods A to-tal of 210 patients with T2DM complicated with ureteral calculi treated from March 2021 to April 2023 were selected and ran-domly divided into observation group(n =105)and control group(n =105).The observation group underwent ureteroscopy combined with lithotripsy,and the control group underwent minimally invasive percutaneous nephrolithotomy.Perioperative in-dicators,stone clearance rate,serum C reactive protein(CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),fasting plasma glucose(FPG),and glycosylated hemoglobin(HbA1c)levels before surgery,and at 3 and 5 d after surgery were compared between the two groups.The survival rate without sepsis in two groups at 2 weeks after surgery was recorded.The influencing factors of sepsis after surgery for T2MD complicated ureteral calculi were analyzed.Results The duration of operation of the observation group was longer than that of the control group,the duration of hematuria and length of postopera-tive hospital stay were shorter than those of the control group,and the amount of intraoperative blood loss was less than that of the control group(P<0.01).The stone clearance rate of the observation group was higher than that of the control group at 7 d and 1 month after operation(P<0.01).The levels of CRP,TNF-α,IL-6,FPG and HbA1c in the two groups at 3 d after operation were higher than those before operation,and lower in the observation group than in the control group(P<0.05,P<0.01).CRP,TNF-α,IL-6,FPG and HbA1c in the two groups were decreased at 5 d after operation,as compared with those before and at 3 d after operation(P<0.05).At 2 weeks after surgery,there was no significant difference in the survival rate without sepsis between the two groups(P>0.05).Gender,age,body mass index,positive urine culture before surgery,and serum CRP,TNF-α,IL-6,FPG and HbA1c at 3 and 5 d after surgery were all influencing factors for postoperative sepsis in T2MD patients with complex ureteral calculi(P<0.01).Conclusion In the treatment of T2DM patients with complex ureteral calculi,ureteroscopy combined with lithotripsy has good efficacy and safety in stone removal,and can effectively re-duce the inflammatory response of the body and help control the level of blood sugar.However,attention should be paid to the factors affecting the occurrence of postoperative sepsis.