输尿管镜碎石术前后尿N-乙酰β-D氨基葡萄糖苷酶变化研究

Characterization of urinary N-acetyl-beta-D-glucosaminidase before and after ureteroscopic lithotripsy

目的探讨经尿道输尿管镜碎石前后尿N-乙酰β-D氨基葡萄糖苷酶(NAG)含量变化特点。方法随机选入76例输尿管结石患者,其中61例行输尿管镜钬激光碎石(腔镜组),15例行输尿管切开取石(开放组),手术时间≤45min为腔镜A组,共38例,手术时间>45min为腔镜B组,共23例。腔镜组中近端输尿管结石22例,远端输尿管结石39例。每位患者均记录手术时间,测定术前、术后第2天及术后第7天尿NAG。结果开放组手术前后尿NAG无明显变化(P>0.05)。腔镜组间,手术时间>45min组术后第2天及第7天尿NAG浓度高于手术时间<45min组(P<0.05);近端输尿管结石术后尿NAG浓度高于远端输尿管结石组(P<0.05)。结论尿NAG可作为输尿管镜碎石术后评价肾损伤的指标,输尿管结石位置较高需要较长时间行输尿管镜碎石治疗时,可能更易引起肾功能损害。

Objective To evaluate the changes of urinary N-acetyl-beta-D-glucosaminidase （NAG） after ureteroscopic lithotripsy. Methods Seventy-six patients with ureteral calculus, fifteen patients underwent ureterolithotomy as open group, and the other 61 patients underwent ureteroscopic lithotripsy as ureteroscope group. In the ureteroscope group, operating time was less than 45 minutes in 38 patients（Group A）, operating time was more than 45 minutes in 23 patients （Group B）. There were 22 cases with proximal ureteral stones, 39 cases with distal ureteral stones. All the patients were determined urinary NAG before operation, two days and seven days after operation. Results There was rio change of urinary NAG in open group （P 〉 0.05）. In the ureteroscope group, the levels of urinary NAG in Group B were increased significanty than （Group A）（P 〈 0.05）, the levels of urinary NAG in the proximal ureteral stone group were increased significantly than the distal ureteral stone group（P 〈 0.05）. Conclusions Urinary NAG can be used as ureteroscopic lithotripsy postoperative evaluation index of kidney damage. Proximal ureteral stones need more time for surgery associated with impaired kidney function.