MPCNL和标准通道PCNL对合并肾功能不全的老年性肾结石患者近期肾功能的影响

Effect of MPCNL and the standard channel PCNL on the recent renal function in elderly patients with renal calculus and renal dysfunction

目的 探讨MPCNL和标准通道PCNL对合并肾功能不全老年性肾结石患者近期肾功能的影响。方法 将2012年10月-2014年8月我院治疗的肾结石并肾功能不全老年性患者100例,采用随机数字表法分为微创组、标准通道组各50例,分别行MPCNL和标准通道PCNL治疗肾结石,术后1周复查血Cr、血BUN、β_2-微球蛋白（BMG）及视黄醇结合蛋白（RBP）,比较两组患者手术前后肾功能变化情况。结果 两组患者围手术期出现并发症发生率无明显差别（P〉0.05）,手术时间〈2 h,术后两组患者血Cr、BUN较术前略有下降,血BMG、RBP较术前略有升高,但差异无统计学意义（P〉0.05）;手术时间≥2 h,术后两组患者血Cr、BUN较术前有所下降,差异无统计学意义（P〉0.05）,但血BMG、RBP较术前明显升高（P〈0.05）。两组患者肾功能改善、稳定和恶化人数比较均无明显差异（P〉0.05）。结论 MPCNL和标准通道PCNL对老年性肾结石伴肾功能不全患者术后早期肾功能无不良影响,而一定程度上可改善患者肾功能。手术时间延长,可致反映早期肾功能损害较灵敏指标血RBP、BMG升高。因此行PCNL时应避免时间过长,从而能最大限度上保护或改善患者现有肾功能。

Objective To investigate the effect of MPCNL and the standard channel PCNL on the recent renal function in elderly patients with renal calculus and renal dysfunction.Methods A total of 100 cases of elderly patients with renal calculus and renal dysfunction from October 2012 to August 2014 in our hospital,were chosen and divided into the minimally invasive group and the standard channel group,with 50 patients in each group.To cure renal calculus,the minimally invasive group received MPCNL treatment,and the standard channel group received the standard channel PCNL treatment.One week after surgery,blood Cr,BUN,β_2-microglobulin（BMG）and retinol-binding protein（RBP）were reviewed,and changes of renal function before and after surgery were compared.Results There was no significant difference in comparing perioperative complication rate of the two groups（P〉0.05）.When the operative time was less than2 hours,blood Cr,BUN of the two groups after treatment decreased a little,compared with those before treatment,and BMG and RBP of the two groups after treatment increased a little,compared with those before treatment.But the differences were not statistically significant（P〈0.05）.When the operation time was 2 hours or more than 2 hours,blood Cr,BUN of the two groups after treatment decreased,compared with those before treatment,and the differences were not statistically significant（P〉0.05）.But BMG and RBP of the two groups after treatment increased significantly,compared with those before treatment（P〈0.05）.There were no significant differences in comparing numbers of patients with improved renal function,with stable renal function or with deteriorated renal function of the two groups（P〉0.05）.Conclusion MPCNL and the standard channel PCNL have no adverse effects on early renal function in elderly patients with renal dysfunction and renal calculus,and can improve renal function to a certain extent.Prolonged surgery time can cause increased RBP and BMG which are more sensitive indicators of early renal damage.Therefore,PCNL treatment should not cost too much time,so that we can maximize the protection or improvement of existing renal function in patients.