多通道经皮肾镜取石术对肾功能的影响及肾功能减退的危险因素分析

Effect of multiple access tracts for percutaneous nephrolithotomy on renal function and analysis of risk factors for renal function deterioration

目的研究多通道经皮肾镜取石术对肾功能的影响及肾功能减退的危险因素。方法选取2013年7月至2014年10月在我院行多通道经皮肾镜取石术肾结石患者160例为研究对象,根据患者基线肾功能将其分为A、B两组。A组患者78例血肌酐浓度正常(<123.8μmol/L),B组患者82例血肌酐浓度偏高(>123.8μmol/L)。评估可能影响患者肾功能变化的各项指标,包括年龄、性别、术前血肌酐浓度、术前肾小球滤过率(GFR)、穿刺数目、高血压及糖尿病等指标。结果 A组患者经皮肾镜取石术前后血肌酐水平几乎保持稳定状态,B组患者术后12个月血肌酐浓度明显增加。对于肾小球滤过率,两组患者(尤其B组)术后均发生显著性降低(P<0.05)。另外,B组中有20例患者发生GFR显著性恶化(与基线相比,GFR降低超过25%)。导致肾功能恶化的独立危险因素包括术前高浓度血肌酐、糖尿病和高血压。结论多通道经皮肾镜取石术对患者的肾功能有不良影响,术前肾损伤、糖尿病及高血压是肾功能减退的潜在危险因素。

Objective To study the effect of multiple access tracts for percutaneous nephrolithotomy on renal function and analyze the risk factors for renal function deterioration. Methods 160 patients undergoing percutaneous nephrolithotomy with multiple access tracts from Jul. 2013 to Oct. 2014 in our hospital were chosen in this study. According to baseline renal function, patients were divided into groups A and B. Group A had 78 patients with normal（〈123.8 μmol/L）serum creatinine, and group B had 82 patients with elevated（〉123.8 μmol/L）serum creatinine. Factors of possible impact on renal function changes were evaluated, including age, sex, preoperative serum creatinine, preoperative glomerular filtration rate （GFR）, number of access tracts, hypertension and diabetes mellitus. Results The serum creatinine level of patients in group A almost kept stable 12 months after the surgery, and that in group B significantly increased. For GFR, both two groups （especially group B） experienced statistically significant worsening（P〈0.05）. Furthermore, 20 patients in group B had a deterioration of GFR （compared to baseline, GFR reduction more than 25 %）. Independent risk factors for this deterioration were elevated （〉 123.8 μmol/L）preoperative serum creatinine, diabetes and hypertension. Oonclusions Percutaneous nephrolithotomy with multiple tracts can adversely affect renal function, and preoperative serum creatinine, diabetes and hypertension are risk fac- tors for significant renal function deterioration.