mPCNL与RIRS对>2 cm肾结石患者一期净石率、肾功能、肾血流动力学及氧化应激反应的影响

Effects of mPCNL and RIRS on the First-Stage Stone Clearance Rate,Renal Function,Renal Hemodynamics and Oxidative Stress Response in Patients with Kidney Stones>20 mm

目的 分析微通道经皮肾镜碎石术(mPCNL)与逆行肾内输尿管软镜碎石术(RIRS)治疗>2 cm肾结石的应用价值。方法 根据手术方式将2019年10月—2022年7月收治的182例>2 cm肾结石分为mPCNL组、RIRS组各91例。比较2组围术期指标、一期净石率、舒适度、手术前后肾功能指标、肾血流动力学指标、氧化应激指标及术后并发症。结果 RIRS组术后血红蛋白下降量、住院时间低于或短于mPCNL组(P<0.01)。2组手术时间、一期净石率比较无显著差异(P>0.05)。RIRS组舒适状况量表评分显著高于mPCNL组(P<0.01)。术后1、3 d 2组中性粒细胞明胶酶相关脂质运载蛋白、肾损伤分子-1、尿素、血肌酐比较无显著差异(P>0.05)。术后1 d RIRS组肾主动脉收缩期峰值流速、收缩期峰值与舒张期流速比值高于mPCNL组(P<0.05,P<0.01)。术后1、3 d RIRS组皮质醇、丙二醛低于mPCNL组,谷胱甘肽过氧化物酶、超氧化物歧化酶高于mPCNL组(P<0.01)。2组术后并发症发生率比较差异无统计学意义(P>0.05)。结论 mPCNL与RIRS治疗>2 cm肾结石可有效清除结石,改善患者肾功能,且安全性较高,但RIRS能优化手术路径,有助于缩短患者恢复进程,提高患者舒适度,降低肾血流动力学损伤,减轻机体氧化应激反应。

Objective To analyze the application value of micro-channel percutaneous nephrolithotripsy(mPCNL)and retrograde intrarenal surgery(RIRS)in the treatment of kidney stones>2 cm.Methods According to surgical methods,182 patients with kidney stones>2 cm admitted from October 2019 to July 2022 were divided into mPCNL group and RIRS group,with 91 cases in each group.Perioperative indexes,first-stage stone clearance rate,comfort level,renal function indexes before and after surgery,renal hemodynamic indexes,oxidative stress indexes and postoperative complications were compared between the two groups.Results The decrease of hemoglobin and length of hospital stay in RIRS group were lower or shorter than those in mPCNL group(P<0.01).There was no significant difference in duration of operation and the first-stage stone clearance rate between the two groups(P>0.05).Comfort scale score of RIRS group was significantly higher than that of mPCNL group(P<0.01).There were no significant differences in neutrophil gelatinase-related lipid carrier protein,kidney injury molecule-1,urea and serum creatinine between the two groups at 1 and 3 d after surgery(P>0.05).The peak systolic velocity of renal aorta,and the ratio of systolic peak flow velocity and diastolic peak flow velocity in RIRS group were higher than those in mPCNL group(P<0.05,P<0.01).At 1 and 3 d after surgery,cortisol and malondialdehyde in RIRS group were lower than those in mPCNL group,while glutathione peroxidase and superoxide dismutase in RIRS group were higher than those in mPCNL group(P<0.01).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion In the treatment of kidney stones>2 cm,mPCNL and RIRS can effectively remove stones and improve renal function with high safety,but RIRS can optimize the surgical approach,help shorten the recovery process of patients,improve the comfort of patients,reduce renal hemodynamic injury,and alleviate oxidative stress response of the body.