体外冲击波碎石与输尿管软镜治疗肾结石对肾功能影响的研究

Study of early postoperative renal function in the shock wave lithotripsy and retrograde intrarenal surgery

目的 探索体外冲击波碎石（SWL）与输尿管软镜治疗（RIRS）肾结石对肾功能的影响.方法 收集2014年6月至2015年6月来本院就诊的符合入选标准的肾结石病例70例,结石最大直径1.0～1.5 cm;随机分组,一组行SWL（35例）,另一组行RIRS（35例）,留取术前、术后2、6、12、24 h、1周、2周的尿液标本,测定NGAL的变化.结果 肾结石SWL和RIRS术后2、6、12、24h尿液NGAL浓度与术前比较均有不同程度升高（P＜0.05）,其中,术后12 h尿液NGAL水平高于其他各时间点,呈峰值状态（P＜0.05）,术后24h逐渐下降.其中术后一周μNGAL浓度与术前比较仍有显著性差异[（5.96±1.5） μg/L和（4.84±0.9） μg/L,P=0.0025],至术后2周基本降至术前水平[（5.01±0.8）μg/L和（4.84±0.9）.μg/L,P=0.346].而RIRS术后一周尿液NGAL浓度与术前比较已无差异[（5.05±0.8） μg/1和（4.84±0.9）μg/L,P =0.445];肾结石SWL后6、12、24、48 h,一周与RIRS比较尿液NGAL均有不同程度升高,且有显著性差异（P＜0.05）.结论 ESWL和RIRS治疗肾结石均引起早期急性肾损伤,并且随着时间呈现出一定的规律.相比较而言,RIRS较ESWL早期的肾损伤更小,且恢复时间快.

Objectives To investigate early postoperative renal function in the shock wave lithotripsy （SWL） and retrograde intrarenal surgery（RIRS）.Methods From June 2014 to June 2015,a prospective study was conducted to compare SWL and RIRS in the treatment of renal calculi which were 1.0-1.5cm in diameter.Seventy patients were randomly divided into the observation group （SWL） and the comrol group（RIRS）.Voided urine samples were collected to detect NGAL level before and 2,6,12,24,48 hours and 1,2 weeks after SWL and RIRS.Results Mean NGAL levels 6,12,24,48 hours and 1 week after SWL and RIRS were significantly increased,reached peak at 12 hours,began to decline after 24 hours.Mean NGAL levels were significantly increased post-SWL when compared with baselinehe baseline within 1 week [（5.96 ± 1.5） μg/L vs.（4.84 ± 0.9） μg/L,P =0.0025],and returned to baseline within 2 weeks post-SWL [（5.01 ± 0.8） μ g/L vs.（4.84 ± 0.9） μg/L,P =0.346],as well as mean NGAL levels were returned to baseline within 1 weeks post-RIBS [（5.05 ±0.8） μg/L vs.（4.84 ±0.9） μg/L,P =0.445].Mean NGAL levels 6,12,24,48 hours and 1 week after SWL were significantly increased when compared with post-RIRS （P ＜ 0.05）.Conclusions SWL and RIRS are both effective on early postoperative renal function.SWL has significantly actute kidney injury when compared with RIRS,and the RIRS time of actute kidney injury recovery is earlier than SWL.