经皮肾镜碎石取石术中放置肾盂造瘘管对肾结石患者围术期指标、炎症因子及术后并发症的影响

The effects of placement of renal pelvis fistula during percutaneous nephrolithotomy on perioperative indexes,inflammatory factors and postoperative complications in patients with renal calculi

目的探讨经皮肾镜碎石取石术(PCNL)中放置肾盂造瘘管对肾结石患者围术期指标、炎症因子、应激指标及术后并发症的影响。方法用抽签法将90例行PCNL的肾结石患者分为置管组(A组)和未置管组(B组)各45例。比较两组患者围术期指标,观察手术前后炎症因子、应激指标的变化情况,记录术后并发症发生情况。结果B组术后1 d VAS评分、术后镇痛药物用量、术后住院时间、医疗费用、止痛药物依赖率均低于A组(P<0.05),两组手术时间、血红蛋白下降值、首次结石清除率、术后并发症发生率比较差异无统计学意义(P>0.05);术后1 d,两组血清CRP、TNF-α、IL-6、IL-8、NE、ET、Cor、ACTH水平均较术前升高(P<0.05),组间炎症因子比较差异无统计学意义(P>0.05),B组应激指标低于A组(P<0.05)。结论PCNL中放置或不放置肾盂造瘘管均可达到良好的治疗效果,置管会对患者造成一定损伤,相比于未置管者术后疼痛明显,镇痛药物用量较多且依赖性更大,应激反应更为强烈,术后恢复更慢,增加医疗费用,但不增加术后感染等并发症发生率,在掌握适应证的基础上提倡不留置肾盂造瘘管。

Objective To explore the effects of placement of renal pelvis fistula during percutaneous nephrolithotomy(PCNL)on perioperative indexes,inflammatory factors,stress indicators and postoperative complications in patients with renal calculi.Methods Ninety patients with renal calculi who underwent PCNL were divided into catheterized group(group A)and non-catheterized group(group B)by a lottery method.The perioperative indexes of the two groups were compared,and the inflammatory factors and stress indicators were observed before and after surgery and the occurrence of postoperative complications were recorded.Results The VAS score after 1 day of surgery,postoperative analgesic drug dosage,postoperative hospital stay,medical expenses and dependence rate of analgesic drugs in the group B were lower or shorter than those in the group A(P<0.05).There were no significant differences in the operative time,decrease of hemoglobin,first stone clearance rate and incidence rates of postoperative complications(postoperative massive hemorrhage,blood transfusion,fever,postoperative infection,urinary extravasation,hydrothorax,and perirenal hematoma)between the two groups(P>0.05).After 1 day of surgery,the serum levels of CRP,TNF-α,IL-6,IL-8,NE,ET,Cor and ACTH in the two groups were increased compared with those before surgery(P<0.05),and there were no significant differences in the inflammatory factors between the two groups(P>0.05).The stress indicators in the group B were lower than those in the group A(P<0.05).Conclusion Placement or non-placement of renal pelvis fistula during PCNL can achieve a good therapeutic effect,but catheterization will cause certain damage to the patients when compared with untreated patient.However,placement of renal pelvis fistula have more obvious postoperative pain,higher dosage of analgesic drugs and greater dependence,more intense stress response,slower postoperative recovery,and increase medical costs although it does not increase the incidence rates of complications such as postoperative infection.On the basis of mastering the indications,it is advocated that the renal pelvis fistula should not be indwelled.