经皮肾镜及输尿管软镜治疗孤立肾肾盂结石的临床疗效及对肾功能影响的比较

Comparison of Percutaneous Neprolithotomy and Flexible Ureteroscopy for Solitary Renal Pelvis Calculi and the Impacts on Renal Function

目的 比较经皮肾镜及输尿管软镜对孤立肾肾盂结石的治疗效果及对肾功能的影响。方法 选取2011年7月～2013年6月我院泌尿外科收治的58例孤立肾肾盂结石，其中30例行经皮肾镜钬激光碎石术（经皮肾镜组），28例行输尿管软镜钬激光碎石术（输尿管软镜组），对手术时间、出血量、结石清除率进行比较，同时测定2组患者术前24h和术后3、24、48h血尿素氮（BUN）、肌酐（Cr）、血中性粒细胞明胶酶相关脂质运载蛋白（NGAL）。结果 经皮肾镜组结石清除率76.7％（23／30），输尿管软镜组结石清除率75.0％（21／28），2组比较无统计学差异（X^2=0.022，P=0.882）。输尿管软镜组出血量（50.3±21.5）ml，显著少于经皮肾镜组（80.2±20.5）ml（t=5.422，P=0.000）；手术时间（60.5±25.1）min，显著长于经皮肾镜组（45.34-10.5）rain（t=-3.045，P=0.004）。术后3h2组血NGAL浓度均明显升高，其中输尿管软镜组从术前（3.6±0.6）μg／L上升到（7.9±0.8）μg／L（g：33.457，P〈0.05），经皮肾镜组从术前（3.8±0.7）μg／L上升到（6.3±0.5）μg／L（q=22.068，P〈0.05），输尿管软镜组高于经皮肾镜组，有显著性差异（t=-9.200，P=0.000），术后24h开始下降，但48h仍未降低至术前水平（q=4.414，P〈0.05；g=8.559，P〈0.05）。2组血BUN、Cr术前后无明显变化（P〉0.05）。结论 经皮肾镜及输尿管软镜均是治疗孤立肾盂结石的有效方法，且2种方法对肾功能均有不同程度影响，但其影响都是可恢复的。

Objective To compare the clinical effect of percutaneous neprolithotomy （PCNL） and flexible ureteroscopy Holmium laser lithotripsy in the treatment of solitary renal pelvis calculi and the impacts on renal function. Methods From July 2011 to June 2013, 58 cases of solitary renal pelvis calculi were treated by holmium laser fithotripsy in our department, of which 30 cases were treated with PCNL （PCNL group）, and 28 cases with electronic flexible ureteroseopy （Flexible ureteroseopy group） respectively. The operative time, blood loss, stone clearance rate of the two groups were compared. Moreover, blood samples of the two groups were analyzed for blood urea nitrogen （BUN）, creatinine （Cr）, neutrophils gelatinase-associatcd lipoealin （NGAL） concentration 24 h before operation and 3, 24, 48 h after operation, respectively. Results There was no statistical difference in stone clearance rate [ 76.2% （ PCNL group） vs. 75.6% （ Flexible ureteroscopy group）, X^2 = 0.022, P = 0.882]. The mean blood loss in Flexible ureteroscopy group was （50.3±21.5） ml, which was less than that of PCNL group （80.2 ＋ 20.5） ml （ t = 5. 422, P = 0.000） , while the operative time was longer than that of PCNL group [（60.5 ± 25.1 ） min vs. （45.3 ± 10.5 ） rain, t = - 3. 045, P = 0. 004]. The serum NGAL in the two groups significantly increased 3 h after operation [PCNL group：（ 3.8±0.7 ）μg/L vs. （6.3±0.5 ）μg/L, q = 22.068,P 〈0.05; Flexible ureteroscopy group ： （3.6 ± 0.6） i.Lg/L vs. （7.9 ± 0.8 ） μg/L, q = 33. 457, P 〈 0.05], with that of Flexible ureteroscopy group being higher than that of the PCNL group [（7.9±0.8） μg/L vs. （6.3 ＋0.5）μg/L, t = -9.200,P = 0.000]. The serum NGAL in the two groups began to decrease 24 h after operation but didn＇ t reach its preoperative level 48 h after operation （q = 4.414, P 〈 0.05 ;q = 8.559, P 〈 0.05 ）. The levels of Cr and BUN in two groups did not show significant changes between preoperation and postoperation （ P 〉 0.05 ）. Conclusion PCNL and flexible ureteroscopy are effective in the treatment of solitary renal pelvis calculi, and both could cause reversible damage on renal function.