腔镜取石治疗输尿管上段结石伴肾功能受损患者对肾功能的影响

Effect of lithotripsy on renal function in patients with upper ureteral stones and renal function impairment

目的探讨腔镜取石术对输尿管上段结石伴肾功能受损患者肾功能的影响。方法回顾性分析2016年4月~2019年3月我院泌尿外科收治的80例采用输尿管上段结石伴同侧肾功能不同程度受损患者的临床资料。根据患者术前肾小球滤过率(GFR)情况分为3组,分别为肾功能中度受损组42例;重度受损组28例;极重度受损组10例。3组患者均行以腔内手术解除梗阻的手术治疗,术后1个月复查,观察并比较3组肾功能指标恢复情况,对于极重度受损组患者,术后随访延长8~12个月,观察肾功能恢复情况。结果中度受损组患者术后1个月肾GFR水平相较于术前明显升高,差异有统计学意义(P<0.05)。重度受损组患者术前与术后1个月肾GFR水平比较,差异有统计学意义(P<0.05)。极重度受损组术后随访8~12个月:肾GFR水平为(12.72±3.60)mL/min,高于术前,差异有统计学意义(P<0.05)。术后1个月3组患者Cr、尿β2-MG、血β2-MG水平相较于术前明显降低,Cys-C较术前降低,差异均具有统计学意义(P<0.05)。3组患者术前、术后1个月Cr、尿β2-MG、血β2-MG相比,中度受损组<重度受损组<极重度受损组,Cys-C水平中度受损组>重度受损组>极重度受损组,差异有统计学意义(P<0.05)。结论对于输尿管上段结石伴同侧肾功能重度受损患者应尽早进行取石手术治疗,解除尿路梗阻,有助于患者肾功能不同程度的恢复。

Objective To explore the effect of lithotripsy on renal function in patients with upper ureteral stones and renal function impairment.Methods The clinical data of 80 patients with upper ureteral calculi and ipsilateral renal function impairment in the Department of Urology,The Second people's Hospital of Neijiang,Sichuan Province from April 2016 to March 2019 were retrospectively analyzed.According to the preoperative glomerular filtration rate(GFR),the patients were divided into three groups,42 cases of moderate renal impairment group.28 cases in severe injury group.There were 10 cases in the extremely severe injury group.All the patients in the three groups were treated with endovascular surgery to relieve obstruction.One month after the operation,the renal function(urinary creatinine(CR),urinary creatinine(CR)and urinary creatinine(BUN)were observed and compared among the three groupsβ2 microglobulin(β2 mg),serumβ2-microglobulin(β The recovery of 2 mg and cystatin C(Cys-C)was observed.For the patients with severe injury,the follow-up period was extended for 8 to 12 months.Results The level of renal GFR in the moderate impaired group was significantly higher than that before operation(P<0.05).The was significant difference in renal GFR level in patients with severe impairment before and after operation(P<0.05).The severely impaired group was followed up for 8-12 months after operation.The renal GFR level(12.72±3.60 mL/min)was higher than that before the operation(P<0.05).The levels of Cr,urinaryβ2-MG and bloodβ2-MG in the three groups were significantly lower than those before operation and Cys-C was lower than that before operation at 1 month after operation(P<0.05).Compared with Cr,urineβ2-MG and bloodβ2-MGin 3 groups of patients before operation and 1 month after operation,moderately impaired group<severely impaired group<Extremely severely impaired group,and moderately damaged Cys-C level was moderately impaired Group>Severely impaired group>Extremely severely impaired group,the difference was statistically significant(P<0.05).Conclusion For upper ureteral calculi with severe impairment of renal function on the same side,early lithotripsy should be performed to relieve urinary obstruction,which is helpful to the recovery of renal function in different degrees.