上段输尿管结石经输尿管镜钬激光与经体外震波碎石术后对肾脏损伤的比较研究

The Early Postoperative Kidney Damage after Treatment of Laser Lithotripsy and Extracorporeal Shock Wave Lithotripsy for Upper Ureteral Calculi

目的对比上段输尿管结石患者经输尿管镜下钬激光碎石术与体外震波碎石术术前、术后尿液中NGAL与α1微球蛋白含量的变化,比较两种治疗方法对肾功能的损害程度。方法筛选我院2014年1月至2014年6月60例单侧上段输尿管结石患者,随机编入输尿管镜钬激光碎石组与体外震波碎石组。留取患者术前2h,术后12h、24h尿液标本,检测不同时间点患者尿液中NGAL与α1微球蛋白含量。结果两组患者术前2h尿液中NGAL、α1-MG差异无统计学意义(P>0.05),术后12h、24h尿液NGAL浓度均高于术前2h(P<0.05)。ESWL组术后12h、24h尿液NGAL浓度高于URL组(P<0.05)。两组患者术后12h、24h尿液α1-MG浓度均高于术前2h(P<0.05)。EWSL组术后12h、24h尿液α1-MG浓度高于URL组(P<0.05)。结论输尿管镜下钬激光碎石术与体外震波碎石术治疗上段输尿管结石均会造成一定程度的肾脏损伤,体外震波碎石术对肾脏的损伤大于输尿管镜下钬激光碎石术。

Objective To compare early renal damage between ureteroscopic holmium laser lithotripsy（ URL）and extracorporeal shock wave lithotripsy（ ESWL） by measuring the changes of Neutrophil gelatinase- associated carrier protein（ NGAL） and α1- microglobulin（ α1- MG） in the preoperative and postoperative. Methods 60 patients with upper ureteral calculi of our hospital from January 2014 to June 2014 were screened and randomly divided into the URL group and ESWL group. Urine samples of two groups at preoperative 2h and postoperative 12,24 h were collected and the contents of NGAL and α1- MG at different time points were detected. Results The difference between the two groups in contents of NGAL and α1- MG at preoperative 2h was not statistically significant（ P〉0. 05）. NGAL＇s value of two groups at postoperative 12,24 h were significantly higher than the value at preoperative 2h（ P〈0. 05）. The concentration of NGAL in ESWL group was significantly higher than that in URL group at postoperative 12,24h（ P〈0. 05）. α1- MG＇s value of two groups at postoperative 12,24 h was significantly higher than that at preoperative 2h（ P〈0. 05）. The concentration ofα1- MG with ESWL group was significantly higher than thar in URL group at postoperative 12,24h（ P〈0. 05）. Conclusion Renal damage could induced by URL and ESWL through treating upper ureteral calculi and ESWL would cause more serious damage than URL in this kind of circumstance.