PCNL联合FU治疗肾结石对肾脏的损伤作用

Effect of PCNL combined with FU on the renal injury after the treatment of renal calculi

目的:探讨经皮肾镜(PCNL)联合输尿管软镜(FU)治疗肾结石对患者肾功能及炎性因子的影响。方法:选取我院治疗的肾结石患者80例进行回顾性分析,收集时间2017年1-8月,根据治疗方法分为研究组(采用PCNL联合FU)和对照组(采用经皮肾镜碎石术)各40例,检测两组患者手术前、手术后24,48,72 h的尿液中肾损伤分子-1(KIM-1)、β2微球蛋白(β2-MG)、γ-谷氨酰胺转移酶(γ-GT)、血清中半胱氨酸蛋白酶抑制剂C(Cys-C)、中性粒细胞明胶海绵酶相关脂质运载蛋白(NAGL)、超氧化物歧化酶(SOD)、丙二醛(MDA)、一氧化氮(NO)、内皮素(ET-1)的变化。结果:研究组患者的结石清除率95. 00%显著高于对照组的80. 00%(P<0. 05);在术后24,48,72 h,两组患者的尿液中的KIM-1、β2-MG、γ-GT水平较术前均显著增高(P<0. 05),两组患者在各个时间点的KIM-1、β2-MG、γ-GT水平比较差异均无统计学意义(P>0. 05);两组患者在术后24,48,72 h的外周血中的Cys-C、NAGL、MDA、NO、ET-1水平较术前均显著增高(P<0. 05),SOD水平较术前均显著的降低(P<0. 05),两组患者在各个时间点Cys-C、NAGL、SOD、MDA、NO、ET-1水平比较差异均无统计学意义(P>0. 05)。结论:PCNL联合FU治疗的肾结石患者效果较好,相对于经皮肾镜碎石术并不会增大对肾脏的损害,并且大部分损害在术后48 h内逐渐恢复。

Objective:To investigate the effect of percutaneous nephrolithotomy(PCNL)combined with ureteroscopic(FU)treatment of renal calculi on renal function and inflammatory factors.Methods:Eighty cases of renal calculi treated in our hospital were retrospectively analyzed from January 2017 to August2017.The patients were divided into study group(treatment using PCNL combined with FU group)and control group(treatment using percutaneous nephrolithotripsy)with 40 cases of each group,then urine levels of KIM-1,β2-microglobulin(MGM)andγ-GT were assayed before operation,24 h,48 h and 72 h after surgery,meanwhile,the serum Cys-C,NAGL,SOD,malondialdehyde(MDA),nitric oxide(NO)and endothelin(ET-1)were also measured.Results:The stone clearance rate in study group was 95.00%,which was significantly higher than that in control group(80.00%,P<0.05).KIM-1 andβ2 in urine were measured 24,48,and 72 h after operation in both groups(P<0.05),but there were no significant differences between the two groups at all time points(P>0.05).The levels of Cys-C,NAGL,MDA,NO,and ET-1 in the peripheral blood of the two groups 24,48,72 h after surgery were significantly higher than those before the operation(P<0.05).There was no signifi-cant differences in the levels of Cys-C,NAGL,SOD,MDA,NO and ET-1 between the two groups at all time points.Conclusion:Compared with percutaneous nephrolithotomy,treatment of PCNL combined with FU for renal stones patients has better results,does not increase the damage to the kid-neys,and most of the damage is gradually restored within 48 h after surgery.