输尿管软镜碎石取石术治疗小肾结石对患者应激反应及肾功能的影响

Effect of flexible ureteroscopic lithotripsy on stress response and renal function in patients with small kidney calculi

目的探讨输尿管软镜碎石取石术(fURL)治疗小肾结石对患者应激反应及肾功能的影响。方法抽取2013年10月至2016年10月郑州市第七人民医院收治的80例小肾结石患者,按随机数表法分为观察组和对照组,每组40例。观察组予以fURL治疗,对照组予以经皮肾镜取石术(PCNL)治疗。比较两组手术相关指标,并分析肾功能指标如血肌酐(Cr)、血清胱抑素C(Cys-C)、N-乙酰-β-D-葡萄糖苷酶(NAG)及β2-微球蛋白(β2-MG)、应激反应指标如促肾上腺皮质激素(ACTH)、血管紧张素-Ⅱ(Ang-Ⅱ)、去甲肾上腺素(NE)、C-反应蛋白(CRP)及皮质醇(COR)的变化情况及术后并发症发生率。结果两组结石清除率比较差异未见统计学意义(P>0.05)。观察组手术时间长于对照组,术中出血量少于对照组,术后尿管放置时间、术后下床时间、术后进食时间、住院时间短于对照组(P<0.05)。术后1、3、5 d,两组Cys-C、NAG、β2-MG呈降低趋势,但均较术前升高(P<0.05)。观察组中术后1、3、5 d Cys-C高于对照组,NAG、β2-MG均低于对照组(P<0.05)。术后1、3、5 d,两组ACTH、Ang-Ⅱ、NE、CRP、COR呈降低趋势,但均较术前升高(P<0.05)。观察组中术后1、3、5 d ACTH、Ang-Ⅱ、NE、CRP、COR均低于对照组(P<0.05)。观察组术后并发症发生率低于对照组(P<0.05)。结论fURL治疗小肾结石临床疗效佳,应激反应轻,术后恢复快,安全性高,可作为小肾结石首选治疗。但fURL可造成肾小管的损害,术后需监测肾小管功能。

Objective To study the effect of flexible ureteroscopic lithotripsy(fURL)on stress response and renal function in patients with small kidney calculi.Methods According to the random number table method,80 cases of small kidney stones in Zhengzhou Seventh People’s Hospital from October 2013 to October 2016 were divided into observation group and control group,with 40 cases in each group.The observation group was treated with fURL,and the control group was treated with percutaneous nephrolithotomy(PCNL).The surgical-related indicators of two groups was compared.The renal functionin dicators such as serum creatinine(Cr),serum cystatin-C(Cys-C),N-acetyl-β-D-glucosidase(NAG),β2-microglobulin(β2-MG),stress response indicators such as adrenocorticotropic hormone(ACTH),angiotensin-2(Ang-Ⅱ),norepinephrine(NE),C-reactive protein(CRP)and cortisol(COR)and postoperative complications was analyzed.Results There was no significant difference in the removal rate of stones between the two groups(P>0.05).The operation time of the observation group was longer than that of the control group;intraoperative bleeding was significantly less than the control group;the time of postoperative catheterization,postoperative time,time of hospitalization and hospital stay were significantly shorter than those of control group(P<0.05).The levels of Cys-C,NAG andβ2-MG in the two groups were decreased in both groups and lower than those before operation at 1,3 and 5 days after operation(P<0.05).Cys-C in the observation group was higher than that in the control group,NAG andβ2-MG were lower than those in the control group at 1,3 and 5 days after operation(P<0.05).The levels of ACTH,Ang-Ⅱ,NE,CRP and COR in the two groups were lower than those before operation at 1,3 and 5 days after operation(P<0.05).The levels of ACTH,Ang-Ⅱ,NE,CRP and COR in the observation group were significantly lower than those in the control group at 1,3 and 5 days after operation(P<0.05).The incidence of postoperative complications in the observation group was significantly lower than that of the control group(P<0.05).Conclusions The treatment of small kidney calculi has good clinical efficacy,light stress response,quick recovery and high safety,so it can be used as the first choice treatment for small kidney calculi.It is necessary to monitor the function of renal tubules after operation.