输尿管软镜对肾结石患者肾损伤因子、凝血功能及氧化应激的影响

Effects of Flexible Ureteroscopy on Renal Injury Factors, Coagulation Function and Oxidative Stress in Patients with Renal Calculi

目的:探讨输尿管软镜对肾结石患者肾损伤因子、凝血功能及氧化应激的影响。方法:回顾性分析2018年9月~2019年9月期间我院收治的200例肾结石患者的临床资料,根据手术方式的不同将患者分为A组(n=100,经皮肾镜取石术)和B组(n=100,输尿管软镜取石术),比较两组患者围术期指标、肾损伤因子、凝血功能及氧化应激指标,并记录两组围术期并发症发生情况。结果:B组手术时间、住院时间短于A组,术中出血量少于A组(P<0.05);两组患者结石清除率比较无差异(P>0.05)。两组术后1 d血清肌酐(Scr)、中性粒细胞明胶酶相关脂质运载蛋白(NGAL)及半胱氨酸蛋白酶抑制剂C(Cys C)水平均升高,但B组低于A组(P<0.05)。两组术后1 d的凝血反应时间(R值)、血凝块形成的时间(K值)均下降,但B组高于A组(P<0.05);两组术后1 d的血块生成率(α角)及最大宽度值(MA值)均升高,但两组比较差异无统计学意义(P>0.05)。两组术后1 d丙二醛(MDA)升高,超氧化物歧化酶(SOD)降低(P<0.05);B组术后1 d的MDA高于A组,SOD则低于A组(P<0.05)。两组术后并发症发生率对比无统计学差异(P>0.05)。结论:与经皮肾镜取石术相比,输尿管软镜取石术可获得相当的治疗效果,其在改善肾功能、凝血功能及氧化应激等方面效果更佳,且不增加并发症发生率,临床应用价值较高。

Objective: To investigate the effects of flexible ureteroscopy on renal injury factors, coagulation function and oxidative stress in patients with renal calculi. Methods: The clinical data of 200 cases of renal calculi admitted to our hospital from September 2018 to September 2019 were retrospectively analyzed, patients were divided into group A(n=100, percutaneous nephrolithotomy) and group B(n=100, flexible ureteroscopic lithotomy) according to different surgical methods, the perioperative indicators, renal injury factors,coagulation function and oxidative stress were compared between the two groups, and perioperative complications in the two groups were recorded. Results: The operative time, hospital stay in group B were shorter than those in group A, and intraoperative bleeding volume was less than that in group A(P<0.05). There was no difference in stone clearance rate between the two groups(P>0.05). Serum creatinine(Scr), neutrophil gelatinase-associated lipocalin(NGAL) and cysteine protease inhibitor C(Cys C) levels were increased in both groups 1 d after operative, but group B lower than group A(P<0.05). The coagulation reaction time(R value) and the formation time of blood clot(K value) in both groups decreased 1 d after operative, but group B was higher than group A(P<0.05). Blood clot formation rate(α angle) and maximum width(MA value) values were increased in both groups 1 d after operative, but there was no statistically significant difference between the two groups(P>0.05). In both groups the malondialdehyde(MDA) level was increased and superoxide dismutase(SOD) level was decreased 1 d after operative(P<0.05), MDA in group B was higher than that in group A 1 d after operative,and SOD was lower than that in group A(P<0.05). There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05). Conclusion: Compared with percutaneous nephrolithotomy, flexible ureteroscopic lithotomy can achieve a considerable therapeutic effect, and it has a better effect in improving renal function, coagulation function and oxidative stress,and does not increase the incidence of complications and has high clinical application value.