不同微创手术对孤立肾结石患者血清细胞因子及肾功能的影响

Effects of different minimally invasive surgery on serum cytokines and renal function in patients with solitary kidney stones

目的探讨输尿管软镜碎石术(f-URS)和微创经皮肾镜碎石术(m-PCNL)治疗孤立肾结石的效果及其对患者血清细胞因子和早期肾功能的影响。方法应用随机数字表法将94例孤立肾结石患者分为f-URS组(47例)和m-PCNL组(47例),比较两组患者的手术相关指标、结石取尽率和并发症发生率;检测并比较两组患者术前和术后6、12、24、48、72 h的肾功能指标和血清相关细胞因子水平。结果(1)f-URS组手术前后血红蛋白下降值及住院时间显著低于m-PCNL组,而住院总费用则明显高于m-PCNL组;f-URS组一期结石取尽率显著高于m-PCNL组,而术后大出血发生率显著低于m-PCNL组(均P<0.05)。(2)f-URS组术后48 h时尿肾损伤因子-1(Kim-1)显著低于m-PCNL组;f-URS组各时间点的血清Cys-C水平均显著低于m-PCNL组(均P<0.05)。(3)两组患者术后白细胞介素-6(IL-6)、白细胞介素-10(IL-10)、皮质醇和白细胞等细胞因子水平均明显高于术前;f-URS组术后各细胞因子水平均明显高于m-PCNL组(均P<0.05)。结论f-URS较m-PCNL术后大出血的发生风险低,对患者早期肾功能和机体应激反应的影响更小,更有利于患者术后恢复。

Objective To investigate the effects of minimally invasive percutaneous nephrolithotomy(m-PCNL)and flexible ureteroscopy(f-URS)in treating solitary kidney stones and their impact on the serum cytokines and early stage renal function.Methods Ninety-four patients with solitary kidney stones were divided into the f-URS group(n=47)and m-PCNL group(n=47)by using the random number table method.The operation related indicators,stone removing rate and complication occurrence rate were compared between the two groups.The levels of serum related cytokines and renal function indexes before operation and in postoperative 6,12,24,48,72 h were detected and compared between the two groups.Results(1)The hemoglobin(Hb)decrease value before and after surgery and hospitalization time in the f-URS group were significantly lower than those in the m-PCNL group,while the hospitalization costs were significantly higher than those in the m-PCNL group;the stone removing rate at the stage 1 in the m-PCNL group was significantly superior to the m-PCNL group,while the occurrence rate of postoperative massive bleeding was significantly lower than those in the m-PCNL group(P<0.05).(2)The postoperative urine Kim-1 level at postoperative 48 h in the f-URS group was significantly lower than that in the m-PCNL group;serum Cys-C level at each time point in the f-URS group was significantly lower than that in the m-PCNL group(P<0.05).(3)The levels of cytokines such as IL-6,IL-10,Cor,and WBC after operation in the two groups were significantly higher than those before operation;the levels of cytokines at postoperative various time points in the f-URS group were significantly higher than those in the m-PCNL group(P<0.05).Conclusion Compared with m-PCNL,f-URS has the lower risk of postoperative massive hemorrhage,less influence on early stage renal function and body stress response,and is more conducive to postoperative recovery.