经皮肾镜取石术联合输尿管软镜钬激光碎石对复杂性肾结石患者尿液代谢及肾损伤指标的影响

Effect of Percutaneous Nephrolithotomy Combined with Flexible Ureteroscopic Holmium Laser Lithotripsy on Urine Metabolism and Renal Injury Indexes in Patients with Complex Renal Calculi

目的探讨经皮肾镜取石术(PCNL)联合输尿管软镜钬激光碎石(FURS)对复杂性肾结石患者尿液代谢及肾损伤指标的影响。方法选取2020年1月-2021年1月我院收治的复杂性肾结石患者84例为研究对象,根据随机数字表法将其分为FURS组和联合组两组。FURS组42例单独实施FURS治疗,联合组42例实施PCNL联合FURS治疗。比较两组手术时间、术后下床时间、住院总时间、结石清除率、并发症发生情况、手术前及术后2周尿液代谢异常发生情况[高钙尿症(IH)、高草酸尿症(PH)、高尿酸尿症、低镁尿症、低枸橼酸尿症]及肾损伤指标[血清肌酐(Cr)、肾小球过滤率(GFR)、尿素(UREA)、血清胱抑素-C(Cys-C)、肾损伤分子-1(KIM-1)]。结果联合组手术用时、术后下床用时、住院总时间短于FURS组(P<0.05);联合组结石清除率高于FRUS组(P<0.05);联合组并发症发生率低于FURS组(P<0.05);两组尿液代谢异常发生率、Cr、GFR、UREA、Cys-C及KIM-1均低于术前,且联合组低于FURS组(P<0.05)。结论复杂性肾结石患者采取PCNL联合FURS治疗方案,既能够提高手术效率、结石清除率、加速术后恢复、减少手术并发症影响,也能够改善尿液代谢异常,减轻肾损伤,应用价值显著。

Objective To investigate the effect of percutaneous nephrolithotomy(PCNL)combined with flexible ureteroscope holmium laser lithotripsy(FURS)on urine metabolism and renal injury indexes in patients with complicated renal calculi.Methods A total of 84 patients with complicated kidney stones admitted from January 2020 to January 2021 were selected as the research objects,and they were divided into FURS group and combined group according to the random number table method.42 patients in the FURS group received FURS treatment alone,and 42 patients in the combined group received PCNL combined with FURS.The operation time,postoperative ambulation time,total hospitalization time,stone clearance rate,occurrence of complications,occurrence of abnormal urine metabolism before operation and 2 weeks after operation[hypercalcemia(IH),hyperoxalic aciduria(PH),hyperuricemia,low magnesiumuria,and low citric aciduria]renal injury indexes[serum creatinine(Cr),glomerular filtration rate(GFR),urea(UREA),serum cystatin-C(Cys-C),renal injury molecule-1(KIM-1)]were compared between the two groups.Results The operation time,postoperative ambulation time and total hospitalization time in the combined group were shorter than those in the FURS group(P<0.05).The stone clearance rate of the combined group was higher than that of the FRUS group(P<0.05).The incidence of complications in the combined group was lower than that in the FURS group(P<0.05).The incidence of urinary metabolic abnormalities,Cr,GFR,UREA,Cys-C and KIM-1 in the two groups were lower than those before operation,and the combined group was lower than the FURS group(P<0.05).Conclusion The treatment of PCNL combined with FURS in patients with complex renal calculi can not only improve the operation efficiency,stone clearance rate,accelerate postoperative recovery,reduce the influence of surgical complications,but also improve urine metabolic abnormalities and reduce renal injury.The application value is remarkable.