肾功能不全患者经皮肾镜碎石临床评价及耐受性评估

Efficacy and tolerability of percutaneous nephrolithotomy in patients with renal insufficiency

目的:评价肾功能不全患者采用经皮肾镜碎石(PCNL)治疗的临床效果和耐受性,进一步探讨PCNL在临床的应用。方法:对32例伴有肾功能不全的结石患者进行PCNL治疗。观察患者术前及术后情况,测定患者入院时、术后1天、术后1周及1个月的血肌酐的变化,衡量PCNL能否改善患者的肾功能。测定患者术前、术后1d血红蛋白、肌酐、白蛋白和血钾的数值,比较患者围手术期血红蛋白、血生化的变化有无意义。结果:32例肾功能不全患者,经行PCNL治疗后,均无明显结石残留,术中及术后也无气胸等其他严重并发症的发生;患者术后1周、1个月的血肌酐水平分别为(253.2±136.2)μmol/L,(235.6±133.7)μmol/L,与入院时血肌酐水平(589.0±368.3)μmol/L相比P<0.05,有统计学意义;患者在围手术期的血红蛋白、血钾、肌酐水平与术后无显著差异。(P>0.05)。结论:PCNL治疗后能改善肾功能不全结石患者的肾功能,对患者围手术期的血生化影响作用不明显,并发症少,手术快速、安全,治疗效果良好,值得在临床推广应用。

Objective： To evaluate the efficacy and tolerability of percutaneous nephrolithotomy （PCNL） in patients with renal insufficiency, and to discuss the clinical application of PCNL. Methods. A total of 32 patients with kidney calculus that were complicated with renal insufficiency were treated with percutaneous nephrolithotomy. Serum cretonne was measured on admission, one week, and one month af- ter PCNL to assess the impact of PCNL on the renal function. Serum potassium, cretonne and albumin were recorded before and one day after the procedure, to compare preoperative and postoperative hemoglo- bin and blood biochemical changes in availability of statistical significance. Results~ All patients had no residual stones and pneumothorax or other serious complications~ According to follow- up, one week, one moth after the surgery, mean serum cretonne decreased respectively to （253.2 -＋-136.2） btmol/L, （235.6 -q-133.7） /~mol/L, both were significant different from （589.0~368.3）/~mol/L on admission （P^0.05）. No statistically significant differences in mean hemoglobin, potassium, serum cretonne and albumin levels were observed （P^0.05）. Oonclusiorl： PCNL is a safe and effective procedure with less complication and high stone free rate for the treatment of patients with kidney calculus and renal insufficiency. It is worthy of clinical application.