无管化经皮肾镜术对出血和肾功能的短期影响

Short-term effects of tubeless percutaneous nephrolithotomy on hematuria and renal function

目的比较标准经皮肾镜取石术(PCNL)和无管化PCNL治疗上尿路结石对出血和肾功能的短期影响。方法前瞻性收集2017年1月至2019年12月收治的上尿路结石,结石长径为1~3cm、集合系统分离2~4cm、肾实质厚度>2cm,以及不伴有严重的心、肺、肝、肾功能不全和凝血功能异常的患者。采用随机数字表法将患者分为两组。两组均行PCNL,标准组术后留置肾造瘘管、双J管和尿管,无管化组术后仅留置双J管和尿管。分别测术前24h、术后即刻、4h、8h、12h、24h、48h肌酐(Scr)、尿素氮(Bun)、半胱氨酸蛋白酶抑制剂C(Cys-C)以及中性粒细胞明胶酶相关脂质运载蛋白(NGAL),术后连续3d收集每位入组患者每个24h的全部尿液,氰化高铁血红蛋白法测定血红蛋白含量。比较两组术式对患者术后出血和肾功能的短期影响。结果本研究共纳入96例患者,每组48例,均顺利完成手术和研究,两组在年龄、性别、合并高血压、合并糖尿病、结石大小的构成比、术前肾积水程度、穿刺通道肾实质厚度、手术时间差异无统计学意义(P>0.05);无管化组术后第一天尿液中血红蛋白含量比标准组多[(10.13.1)g与(8.22.2)g,P<0.01],而术后第2d[(2.91.3)g与(4.21.8)g,P<0.01]、第3d[(0.580.23)g与(1.110.31)g,P<0.01]尿液中血红蛋白含量比标准组少;两组即刻抽血查Cys-C和NGAL均有升高(P<0.05),但无管化组术后8h达峰值(789.62±58.93μg/L和561.47±56.49μg/L),而标准组术后24h达峰值(812.15±87.48μg/L和823.46±49.12μg/L),标准组术后4h、8h、12h、24h、48h的Cys-C和NGAL均高于无管化组(P<0.05),两组SCr和BUN无统计学差异(P>0.05)。两组均未输血,无感染性休克、严重感染等并发症。结论无管化PCNL较标准PCNL,有创面的愈合早、术后血尿时间短、肾功能恢复快的优点。

Objective Short-term effects of standard percutaneous nephrolithotomy(PCNL)and tubeless PCNL on upper urinary tract calculi on bleeding and renal function.Methods From January 2017 to December 2019,patients who met the criteria(stones between l~3 cm,collection system separated by 2~4cm,thickness of renal parenchyma>2cm and without serious heart,lung,1iver and kidney dysfunction and coagulation dysfunction)and underwent PCNL were prospectively enrolled and randomized into 2 groups,standard PCNL group and tubeless PCNL group.The creatinine(Scr),urea nitrogen(Bun),cysteine protease inhibitor C(Cys-C),and neutrophil gelatinase(NGAL)were respectively measured 24h before operation and immediately 4h,8h,12h,24h,48h after operation.The urine of each patient was collected for 24 h after 3 consecutive days,and the hemoglobin content was measured by cyanmethemoglobin.The short-term effects of postoperative bleeding and renal function were compared between the two groups.Results A total of 96 patients were enrolled in the analysis,48 patients in each group,and successfully completed the study.There was no significant difference in the composition ratio between the two groups in age,gender,combined hypertension,combined diabetes,and stone size(P>0.05);The hemoglobin content in the urine of the tubeless group was higher than the standard group on the first day after surgery[(10.13.1)g vs(8.22.2)g,P<0.01],and the second day after surgery[(2.91.3)g vs(4.21.8)g,P<0.01],the third day[(0.580.23)g vs(1.110.31)g,P<0.01]urine hemoglobin content is less than the standard group;Cys-C and NGAL were elevated immediately after operation in both groups(P<0.05),but peaked at 8 hours(789.62±58.93μg/L and 561.47±56.49μg/L)in the tubeless group,while the standard group peaked in 24h(812.15±87.48μg/L and 823.46±49.12μg/L),and the Cys-C and NGAL in the standard group at 4h,8h,12h,24h and 48h were higher than tubeless group(P<0.05).There was no significant difference in SCr and BUN between the two groups(P>0.05).No blood transfusion,interventional embolization,septic shock and other serious infection complications were found in the two groups.Conclusion Compared with standard PCNL,tubeless PCNL have the advantages of early wound healing,shorter postoperative hematuria time,and faster renal function recovery.