微创经皮肾镜取石术治疗复杂性肾结石的效果及对机体应激反应和肾功能的影响

Effect of Minimally Invasive Percutaneous Nephrolithotomy in the Treatment of Complex Renal Stones and Its Influence on Body Stress Response and Renal Function

目的:探讨采取微创经皮肾镜取石术(PCNL)治疗复杂性肾结石的效果及对机体应激反应和肾功能的影响。方法:选取2020年1月-2023年1月中山大学附属第五医院泌尿外科收治的160例复杂性肾结石患者为研究对象,按照随机数表法将其分成观察组与对照组,各80例。对照组采取标准通道PCNL治疗,观察组采取微创PCNL治疗。比较两组结石清除率、围手术期指标、机体应激反应指标[血清内皮素(ET)、促肾上腺皮质激素(ACTH)]、肾功能指标[胱抑素C(Cys C)、肾损伤分子-1(KIM-1)]、术后并发症发生率。结果:两组结石清除率比较,差异无统计学意义(χ^(2)=0.339,P=0.560)。观察组术后排气时间、下床活动时间早于对照组,手术时间、住院时间、切口长度短于对照组,术中出血量少于对照组,差异有统计学意义(P<0.05)。术后1 d、3 d,观察组ET、ACTH、Cys C、KIM-1水平均低于对照组,差异有统计学意义(P<0.05)。观察组术后并发症总发生率低于对照组,差异有统计学意义(χ^(2)=5.958,P=0.015)。结论:采取微创PCNL治疗复杂性肾结石手术时间短、手术创伤小及术后康复快,术后并发症总发生率低,减轻机体应激反应,减小肾脏损伤。

Objective:To investigate the effect of minimally invasive percutaneous nephrolithotomy(PCNL)in the treatment of complex renal stones and its influence on body stress response and renal function.Method:A total of 160 patients with complex kidney stones admitted to the Department of Urology,the Fifth Affiliated Hospital Sun Yat-sen University from January 2020 to January 2023 were selected as study objects,they were divided into observation group and control group according to random number table method,with 80 cases in each group.The control group received standard channel PCNL treatment,and the observation group received minimally invasive PCNL treatment.The stone clearance rate,perioperative indexes,body stress response indexes[serum endothelin(ET),adrenocorticotropin(ACTH)],renal function indexes[cystatin C(Cys C),kidney injury molecular-1(KIM-1)]and postoperative complication rate were compared between the two groups.Result:There was no significant difference in stone clearance rate between the two groups(χ^(2)=0.339,P=0.560).The postoperative exhaust time and getting out of bed time in the observation group were earlier than those in the control group,the operation time,hospital stay and incision length were shorter than those in the control group,and the intraoperative blood loss was less than that in the control group,the differences were statistically significant(P<0.05).At 1 d and 3 d after operation,the levels of ET,ACTH,Cys C and KIM-1 in observation group were lower than those in control group,and the differences were statistically significant(P<0.05).The total incidence of postoperative complications in the observation group was lower than that in the control group,the difference was statistically significant(χ^(2)=5.958,P=0.015).Conclusion:Minimally invasive PCNL in the treatment of complex kidney stones has short operation time,less surgical trauma and rapid postoperative recovery,low overall incidence of postoperative complications,alleviating the body's stress response and reducing kidney damage.