输尿管软镜与经皮肾镜治疗肾结石的相关研究

Comparative study of flexible ureteroscopy and percutaneous nephroscopy for renal calculi

目的探讨输尿管镜与经皮肾镜对术后肾功能、凝血功能及氧化应激产物的影响。方法选取该院收治的肾结石患者52例,随机分为经皮肾镜组和输尿管镜组,每组各26例,经皮肾镜组给予经皮肾镜钬激光碎石术治疗,输尿管镜组给予输尿管镜钬激光碎石术治疗,术后对患者的肾功能、凝血功能、氧化应激产物及治疗效果进行检测。结果术后输尿管镜组与经皮肾镜组比较:(1)输尿管镜组血清Scr、NGAL、Cys C和MDA水平较低,血清R、K和GSH-Px水平较高,α、MA水平较低;(2)输尿管镜组的术中出血量较低,清石率较高。结论与经皮肾镜比较,输尿管镜对肾结石患者肾功能、凝血功能的影响更小,氧化应激反应较轻,术中出血量较低,清石率较高,对临床有指导意义。

Objective To compare the effect of ureteroscopy and percutaneous nephrolithotomy on postoperative renal function, coagulation function and oxidative stress products in patients with renal calculi.Methods Fifty-two patients who were diagnosed with renal calculus in our hospital were collected. The patients were randomly divided into percutaneous nephroscopic group and ureteroscopic group, 26 cases in each group. The percutaneous nephroscopic group was given percutaneous holmium laser lithotripsy through nephroscope, the ureteroscopic group was treated with nephroscopic holmium laser lithotripsy. After treatment,the indexes of renal function, coagulative function and oxidative stress and treatment effect were detected in all patients. Results After operation, compared with percutaneous nephroscopic group, the serum levels of creatinine, NGAL, Cys C and MDA, and the α and MA values of thromboelastogram（TEG） were lower; and the R and K values of TEG and serum GSH-Px level were higher; the amount of blood loss was smaller and the rate of stone clearance was higher in the ureteroscopic group; the differences were statistically significant（P〈0.05）. Conclusions Compared with percutaneous nephroscopic holmium laser lithotripsy, ureteroscopic holmium laser lithotripsy has less influence on renal function, blood coagulative function and the oxidative stress reaction in patients with kidney stones; the amount of intraoperative blood loss is smaller, the rate of stone clearance is higher, which have guiding significance for clinic.