输尿管软镜钬激光碎石术和经皮肾镜碎石术对上尿路结石患者肾功能及炎症因子的影响

Effects of flexible ureteroscopic holmiumlaser lithotripsy and percutaneous nephrolithotripsy on renal function and inflammatory factor in patients with upper urinary calculi

目的探讨输尿管软镜钬激光碎石术(FURL)和经皮肾镜碎石术(PCNL)对上尿路结石患者肾功能及炎症因子的影响。方法回顾性分析2018年1月~2020年12月期间河北燕达医院泌尿外科上尿路结石患者129例,依据手术方式分为FURL组51例和PCNL组78例。对比两组患者结石清除率、并发症、手术前后肾功能指标及炎症因子变化。结果FURL组与PCNL组的清石率相比(88.24%vs.93.59%),差异无统计学意义(P>0.05);FURL组较PCNL组手术时间[(54.25±9.61)min与(71.67±13.68)min]、失血量[(10.26±2.15)与(48.72±6.19)ml]和住院时间[(6.55±1.06)d与(9.12±1.42)d]明显减少,术后并发症发生率[9.80%(5/51)与24.36%(19/78)]降低,差异均有统计学意义(P<0.05)。术后1 d和7 d时,FURL组血肌酐、中性粒细胞明胶酶相关载脂蛋白、胱抑素C水平和血清降钙素原、超敏C反应蛋白水平均明显低于PCNL组,差异均有统计学意义(P<0.05)。结论PCNL术和FURL术治疗上尿路结石均具有较高的清石率,其中FURS术安全性更高,对肾功能影响小,且炎症应激反应更轻。

Objective To investigate the effect of FURL and PCNL on renal function and inflammatory factor in patients with upper urinary calculi.Methods 129 patients with upper urinary calculi in our hospital from January 2018 to December 2020 were retrospectively analyzed.Those patients were divided into FURL group 51 cases and PCNL group(78 cases)according to the operation method.The calculi clearance rate and complications were compared between the two groups,and the changes of renal function index and inflammatory factor before and after operation were observed.Results The stone clearing rate between FURL group and PCNL group[88.24%(45/51)vs.93.59%(73/78)]had no significant difference(P>0.05).The FURL group were significantly less than PCNL group in operation time[(54.25±9.61)min vs.(71.67±13.68)min],blood loss[(10.26±2.15)mL vs.(48.72±6.19)mL]and hospital stay[(6.55±1.06)d vs.(9.12±1.42)d],and the incidence of postoperative complications in FURL group was also significantly lower than that in PCNL group[9.80%(5/51)vs.24.36%(19/78)],with significant difference(P<0.05).At 1d and 7d after surgery,Scr,NGAL,CysC and PCT,hs-CRP levels in the FURL group were significantly lower than those in the PCNL group(P<0.05).Conclusion Both PCNL and FURL have higher stone removal rates for upper urinary calculi,among which FURS has higher safety,less impact on renal function and has less inflammatory stress.