糖尿病患者与非糖尿病患者肾结石行微创经皮肾取石术的比较

Comparison of minimally invasive percutaneous renal stone removal in diabetic patients and non-diabetic patients

目的:探讨比较糖尿病患者与非糖尿病患者肾结石行微创经皮肾取石术的临床疗效。方法:回顾性分析2007年5月至2016年6月2 796例中582例糖尿病患者肾结石(糖尿病组)在X线引导下行F18微创经皮肾取石术,年龄为26~82岁,男279例,女303例,其中肾盂结石174例,多发性结石255例,鹿角状结石153例,空腹血糖5.4~20.3 mmol/L,餐后2 h血糖9.1~28.9 mmol/L,术前均行空腹血糖、糖化血红蛋白、餐后2 h血糖、免疫糖尿病2项等检查,均符合WHO糖尿病诊断及分型标准,结石标本均行红外线光谱自动分析仪器测定结石成分。剩下的2 214例非糖尿病肾结石患者作为非糖尿病组。对两组患者的手术时间、结石取净率、手术并发症、住院天数进行评估。结果:糖尿病患者组手术时间、结石取净率、手术并发症与非糖尿病患者组差异无统计学意义(P>0.05);而糖尿病患者组住院天数明显高于非糖尿病患者组(P<0.05);糖尿病患者组与非糖尿病患者组的结石成分相比,尿酸结石的发病率更高,两组之间差异有统计学意义(P<0.05)。结论:微创经皮肾取石术治疗糖尿病患者肾结石是安全、有效的。针对糖尿病患者具有较高形成尿酸结石的风险和血糖控制欠佳的患者结石复发率高的特点,提醒泌尿外科医师对糖尿病人群进行结石预防的重要性。

Objective To study the clinical effect of minimally invasive percutaneous nephrolithotomy in patients with diabetes mellitus and non-diabetic patients. Methods A retrospective analysis was performed to look into the clinical data of 2,796 patients undergoing downward F18minimally invasive percutaneous nephrolithotomy during May 2007 to June 2016 under X-ray guidance Among them, 582 diabetic patients were assigned as the diatetes group, aged 26-82 years, 279 male, 303 female, 174 with pelvic stones, 255 with multiple calculi, 153 with staghorn calculi, fasting blood glucose 5.4 - 20.3 retool/L, postprandial and 2 hours blood glucose 9.1 - 28.9 mmol/L. In the group, the results of preoperative fasting blood glucose, glycosylated hemoglobin, meal 2 hours blood glucose, diabetes mellitus immune and two others, were in line with diabetes diagnosis and typing standard, and the stones were tested by infrared spectrum analyzer for determination of chemical composition （P 〈 0.05）. The rest 2,214 diabetic patients were set as non-diabetic group. The two groups were compared in terms of the operation duration, the rate of stone removal, surgical complications and hospital stay. Results There were no significant differenices in the operation duration, rate of stone removal and operative complications between the two groups （P 〉 0.05） , but the hospital stay in the diabetic group was significantly longer than that of the control group. In comparison of the stone compositions, therate of uric acid stones in the diabetic group was significantly higher than that of the control group （P 〈 0.05）. Conclusion Minimally invasive percutaneous nephrolithotomy is safe and effective for the treatment of renal calculi in patients with diabetes mellitus. Diabetic patients are susceptive to uric acid stones and those patients at the poor control of blood glucose suffer from a higher recurrence of renal stones, which reminds the importance of doctors to educate the patients on the prevention of kidney stones.